Diabetes mellitus type 2 laboratory findings: Difference between revisions
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==Overview== | ==Overview== | ||
Laboratory findings of diabetes mellitus type 2 are diagnostic for this disease. Diabetes may be diagnosed based on [[plasma glucose]] criteria, either the [[fasting plasma glucose]] (FPG) or the 2-h plasma glucose (2-h PG) value after a 75-g [[oral glucose tolerance test]] (OGTT) or [[A1C]] criteria. All of these measurements are equally appropriate in diagnosis. | [[Laboratory]] findings of [[diabetes mellitus type 2]] are diagnostic for this disease. [[Diabetes]] may be diagnosed based on [[plasma glucose]] criteria, either the [[fasting plasma glucose]] ([[Blood sugar|FPG]]) or the 2-h plasma glucose (2-h PG) value after a 75-g [[oral glucose tolerance test]] ([[Glucose tolerance test|OGTT]]) or [[A1C]] criteria. All of these measurements are equally appropriate in diagnosis. | ||
==Laboratory Findings== | ==Laboratory Findings== | ||
Diabetes may be diagnosed based on plasma glucose criteria, either the [[fasting plasma glucose]] (FPG) or the 2- | |||
All of them are equally appropriate for diagnosis. | * [[Diabetes]] may be diagnosed based on [[Blood sugar|plasma glucose]] criteria, either the [[fasting plasma glucose]] (FPG) or the 2-hour [[Blood sugar|plasma glucose]] (2-h PG) value after a 75-g [[oral glucose tolerance test]] ([[Glucose tolerance test|OGTT]]) or [[A1C]] criteria. All of them are equally appropriate for [[diagnosis]]. Two tests that are commonly used to determine whether you have [[Prediabetes|pre-diabetes]] or [[diabetes]] are the [[fasting plasma glucose]] test (FPG) or the [[oral glucose tolerance test]] ([[Glucose tolerance test|OGTT]]). | ||
Two tests that are commonly used to determine whether you have pre-diabetes or diabetes are the [[fasting plasma glucose]] test (FPG) or the [[oral glucose tolerance test]] (OGTT). The blood glucose levels measured after these tests determine whether you have a normal metabolism, or whether you have | * The [[Blood sugar|blood glucose]] levels measured after these tests determine whether you have a normal metabolism, or whether you have [[prediabetes]] or [[diabetes]]. | ||
* If your [[Blood sugar|blood glucose]] level is abnormal following the FPG, you have [[impaired fasting glucose]] (IFG); if your [[Blood sugar|blood glucose]] level is abnormal following the [[Glucose tolerance test|OGTT]], you have impaired [[Glucose tolerance test|glucose tolerance]] (IGT). | |||
[[Image:FPG-new.gif|200px]] [[Image:OGTTColorfinal.gif|200px|OGTT]] | [[Image:FPG-new.gif|200px]] [[Image:OGTTColorfinal.gif|200px|OGTT]] | ||
FPG OGTT | FPG [[Glucose tolerance test|OGTT]] | ||
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===Fasting and 2-Hour Plasma Glucose=== | ===Fasting and 2-Hour Plasma Glucose=== | ||
The [[Fasting plasma glucose|FPG]] and 2- | |||
* The [[Fasting plasma glucose|FPG]] and 2-hour [[Blood sugar|PG]] may be used to [[Diagnosis|diagnose]] [[Diabetes mellitus|diabetes]]. | |||
===Hb A1C=== | ===Hb A1C=== | ||
The [[A1C]] test should be performed using a method that is certified by the [http://www.ngsp.org NGSP] and standardized or traceable to the Diabetes Control and Complications Trial (DCCT) reference assay. | |||
* The [[A1C]] test should be performed using a method that is certified by the [http://www.ngsp.org NGSP] and standardized or traceable to the Diabetes Control and Complications Trial (DCCT) reference assay. | |||
==== Advantages of HbA1C ==== | ==== Advantages of HbA1C ==== | ||
* [[HbA1C]] is more closely associated with both microvascular and macrovascular complications. | * [[HbA1C]] is more closely associated with both [[Microvascular Complications and Foot Care|microvascular]] and [[Macrovascular disease|macrovascular]] [[Complication (medicine)|complications]]. | ||
* Greater availability and standardization of the procedure to measure [[HbA1C]] has helped in its wider use. | * Greater availability and standardization of the procedure to measure [[HbA1C]] has helped in its wider use. | ||
* Relatively less preanalytical and analytical variability. | * Relatively less preanalytical and analytical variability. | ||
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==== Disadvantages of HbA1C ==== | ==== Disadvantages of HbA1C ==== | ||
* | * Expensive method | ||
* Still not widely available in developing countries | * Still not widely available in developing countries | ||
* Incorrect estimates in patients with certain forms of anemia and hemoglobinopathies. | * Incorrect estimates in patients with certain forms of [[anemia]] and [[Hemoglobinopathy|hemoglobinopathies]]. | ||
** In patients with [[sickle cell anemia]] (abnormal [[hemoglobin]], but normal red cell turnover) an A1C assay without interference from abnormal hemoglobin should be used | ** In patients with [[sickle cell anemia]] (abnormal [[hemoglobin]], but normal red cell turnover) an [[Glycosylated hemoglobin|A1C]] assay without interference from abnormal [[hemoglobin]] should be used | ||
** In patients with anemia from [[hemolysis]] and [[iron deficiency]] (abnormal red cell turnover) the diagnosis of diabetes should be done based on glucose criteria exclusively. | ** In patients with [[anemia]] from [[hemolysis]] and [[iron deficiency]] (abnormal red cell turnover) the [[diagnosis]] of [[diabetes]] should be done based on [[glucose]] criteria exclusively. | ||
* Glycation rates differ with race. A recent epidemiological study <ref>{{Cite journal| author = [[Elizabeth Selvin]], [[Michael W. Steffes]], [[Christie M. Ballantyne]], [[Ron C. Hoogeveen]], [[Josef Coresh]] & [[Frederick L. Brancati]] | *[[Glycation]] rates differ with [[race]]. A recent [[epidemiological study]] <ref>{{Cite journal| author = [[Elizabeth Selvin]], [[Michael W. Steffes]], [[Christie M. Ballantyne]], [[Ron C. Hoogeveen]], [[Josef Coresh]] & [[Frederick L. Brancati]] | ||
| title = Racial differences in glycemic markers: a cross-sectional analysis of community-based data | | title = Racial differences in glycemic markers: a cross-sectional analysis of community-based data | ||
| journal = [[Annals of internal medicine]] | | journal = [[Annals of internal medicine]] | ||
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| pmid = 21357907 | | pmid = 21357907 | ||
}}</ref> found higher HbA1c rates in African American population than whites for matched levels of fasting blood glucose. However this population was also found to have higher rates of [[fructosamine]] and glycated [[albumin]] along with lower 1,5 anhydroglucitol which was concordant with the higher HbA1c levels. Further, racial differences in the rates of hemoglobin [[glycation]] and erythrocyte turnover was not enough to explain the higher HbA1c levels. Differences in post-prandial glucose levels in different races is controversial and warrants further studies. | }}</ref> found higher [[Glycosylated hemoglobin|HbA1c]] rates in African American population than whites for matched levels of fasting [[Blood sugar|blood glucose]]. However this population was also found to have higher rates of [[fructosamine]] and glycated [[albumin]] along with lower 1,5 anhydroglucitol which was concordant with the higher [[Glycosylated hemoglobin|HbA1c]] levels. Further, racial differences in the rates of [[hemoglobin]] [[glycation]] and [[Red blood cell|erythrocyte]] turnover was not enough to explain the higher [[Glycosylated hemoglobin|HbA1c]] levels. Differences in post-prandial [[glucose]] levels in different races is controversial and warrants further studies. | ||
=== American Diabetes Association Diabetes Diagnostic Criteria 2017 (DO NOT EDIT)<ref name="pmid27979887">{{cite journal |vauthors= |title=Standards of Medical Care in Diabetes-2017: Summary of Revisions |journal=Diabetes Care |volume=40 |issue=Suppl 1 |pages=S4–S5 |year=2017 |pmid=27979887 |doi=10.2337/dc17-S003 |url=}}</ref>=== | === American Diabetes Association Diabetes Diagnostic Criteria 2017 (DO NOT EDIT)<ref name="pmid27979887">{{cite journal |vauthors= |title=Standards of Medical Care in Diabetes-2017: Summary of Revisions |journal=Diabetes Care |volume=40 |issue=Suppl 1 |pages=S4–S5 |year=2017 |pmid=27979887 |doi=10.2337/dc17-S003 |url=}}</ref>=== | ||
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!align="center" style="background:#DCDCDC;"|'''Criteria for the diagnosis of diabetes''' | !align="center" style="background:#DCDCDC;"|'''Criteria for the diagnosis of diabetes''' | ||
|- | |- | ||
|align="left" style="background:#F5F5F5;"|[[Fasting plasma glucose|FPG]] ≥126 mg/dL (7.0 mmol/L). Fasting is defined as no caloric intake for at least 8 | |align="left" style="background:#F5F5F5;"|[[Fasting plasma glucose|FPG]] ≥126 mg/dL (7.0 mmol/L). Fasting is defined as no caloric intake for at least 8 hours. | ||
|- | |- | ||
|align="center" style="background:#F5F5F5;"|'''OR''' | |align="center" style="background:#F5F5F5;"|'''OR''' | ||
|- | |- | ||
|align="left" style="background:#F5F5F5;"|2- | |align="left" style="background:#F5F5F5;"|2-hour [[Blood glucose|Plasma Glucose]] (PG) ≥200 mg/dL (11.1 mmol/L) during an [[Glucose tolerance test|OGTT]]. The test should be performed as described | ||
by the [[WHO]], using a glucose load containing the equivalent of 75 g anhydrous glucose dissolved in water. | by the [[WHO]], using a [[glucose]] load containing the equivalent of 75 g [[anhydrous]] [[glucose]] dissolved in water. | ||
|- | |- | ||
|align="center" style="background:#F5F5F5;"|'''OR''' | |align="center" style="background:#F5F5F5;"|'''OR''' | ||
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|align="center" style="background:#F5F5F5;"|'''OR''' | |align="center" style="background:#F5F5F5;"|'''OR''' | ||
|- | |- | ||
|align="left" style="background:#F5F5F5;"|In a patient with classic symptoms of [[hyperglycemia]] or [[hyperglycemic]] crisis, a random [[plasma glucose]] ≥200 mg/dL (11.1 mmol/L). | |align="left" style="background:#F5F5F5;"|In a patient with classic [[Symptom|symptoms]] of [[hyperglycemia]] or [[hyperglycemic]] crisis, a random [[plasma glucose]] ≥200 mg/dL (11.1 mmol/L). | ||
|} | |} | ||
The abnormal test should be repeated to rule out laboratory error, unless the diagnosis of diabetes is evident from the clinical presentation. The same test should be preferably repeated to confirm the diagnosis. If two different tests show a discordant result, then the test with abnormal result should be preferably repeated and diagnosis be made based on the results of that particular test. For | The abnormal test should be repeated to rule out laboratory error, unless the diagnosis of [[diabetes]] is evident from the clinical presentation. The same test should be preferably repeated to confirm the [[diagnosis]]. If two different tests show a discordant result, then the test with abnormal result should be preferably repeated and [[diagnosis]] be made based on the results of that particular test. For example, if a patient has a normal fasting [[Blood sugar|blood glucose]] and two abnormal [[HbA1c]]'s, then the [[diagnosis]] of [[diabetes]] can be confirmed based on the two abnormal [[Glycosylated hemoglobin|HbA1c's]]. | ||
Most of the patients with higher variability in their tests for diagnosing diabetes, have borderline abnormal results on repeat testing. Such patients may be followed up in 3 to 6 months for repeat testing. | * Most of the patients with higher variability in their tests for diagnosing [[Diabetes mellitus|diabetes]], have borderline abnormal results on repeat testing. Such patients may be followed up in 3 to 6 months for repeat testing. | ||
=== Impaired Glucose Tests/Pre-Diabetes === | === Impaired Glucose Tests/Pre-Diabetes === | ||
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center | * In 1997 and 2003, the International Expert Committee on [[Diagnosis]] and [[Classification]] of [[diabetes mellitus]] recognized an intermediate group of patients who did not meet the diagnostic criteria for [[diabetes mellitus]] and at the same time had a borderline abnormal [[glucose]] test result. These individuals were termed as "[[Prediabetes|prediabetics]]". | ||
!align="center" style="background:#DCDCDC|Categories of increased risk for diabetes (prediabetes) | * The patients with impaired fasting glucose have higher risks of developing [[diabetes]] and [[cardiovascular disease]]. | ||
* The glucose level used to diagnose impaired [[glucose]] tests are: | |||
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center" | |||
! align="center" style="background:#DCDCDC" |Categories of increased risk for diabetes (prediabetes) | |||
|- | |- | ||
|align="left" style="background:#F5F5F5;"|[[Fasting plasma glucose|FPG]] 100 mg/dL (5.6 mmol/L) to 125 mg/dL (6.9 mmol/L) ([[Impaired fasting glucose|IFG]]) | | align="left" style="background:#F5F5F5;" |[[Fasting plasma glucose|FPG]] 100 mg/dL (5.6 mmol/L) to 125 mg/dL (6.9 mmol/L) ([[Impaired fasting glucose|IFG]]) | ||
|- | |- | ||
|align="center" style="background:#F5F5F5;"|'''OR''' | | align="center" style="background:#F5F5F5;" |'''OR''' | ||
|- | |- | ||
|align="left" style="background:#F5F5F5;"|2- | | align="left" style="background:#F5F5F5;" |2-hour [[Plasma glucose|PG]] in the 75-g [[OGTT]] 140 mg/dL (7.8 mmol/L) to 199 mg/dL (11.0 mmol/L) ([[Impaired glucose tolerance|IGT]]) | ||
|- | |- | ||
|align="center" style="background:#F5F5F5;"|'''OR''' | | align="center" style="background:#F5F5F5;" |'''OR''' | ||
|- | |- | ||
|align="left" style="background:#F5F5F5;"|[[A1C]] 5.726.4% (39247 mmol/mol) | | align="left" style="background:#F5F5F5;" |[[A1C]] 5.726.4% (39247 mmol/mol) | ||
|} | |} | ||
Revision as of 19:05, 7 August 2020
Diabetes mellitus type 2 Microchapters |
Differentiating Diabetes Mellitus Type 2 from other Diseases |
Diagnosis |
Treatment |
Medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]
Overview
Laboratory findings of diabetes mellitus type 2 are diagnostic for this disease. Diabetes may be diagnosed based on plasma glucose criteria, either the fasting plasma glucose (FPG) or the 2-h plasma glucose (2-h PG) value after a 75-g oral glucose tolerance test (OGTT) or A1C criteria. All of these measurements are equally appropriate in diagnosis.
Laboratory Findings
- Diabetes may be diagnosed based on plasma glucose criteria, either the fasting plasma glucose (FPG) or the 2-hour plasma glucose (2-h PG) value after a 75-g oral glucose tolerance test (OGTT) or A1C criteria. All of them are equally appropriate for diagnosis. Two tests that are commonly used to determine whether you have pre-diabetes or diabetes are the fasting plasma glucose test (FPG) or the oral glucose tolerance test (OGTT).
- The blood glucose levels measured after these tests determine whether you have a normal metabolism, or whether you have prediabetes or diabetes.
- If your blood glucose level is abnormal following the FPG, you have impaired fasting glucose (IFG); if your blood glucose level is abnormal following the OGTT, you have impaired glucose tolerance (IGT).
FPG OGTT
Fasting and 2-Hour Plasma Glucose
Hb A1C
- The A1C test should be performed using a method that is certified by the NGSP and standardized or traceable to the Diabetes Control and Complications Trial (DCCT) reference assay.
Advantages of HbA1C
- HbA1C is more closely associated with both microvascular and macrovascular complications.
- Greater availability and standardization of the procedure to measure HbA1C has helped in its wider use.
- Relatively less preanalytical and analytical variability.
- Physicians are familiar with the method.
- Convenient for patient as no fasting required.
- Minimal variability due to stress and other illnesses.
Disadvantages of HbA1C
- Expensive method
- Still not widely available in developing countries
- Incorrect estimates in patients with certain forms of anemia and hemoglobinopathies.
- In patients with sickle cell anemia (abnormal hemoglobin, but normal red cell turnover) an A1C assay without interference from abnormal hemoglobin should be used
- In patients with anemia from hemolysis and iron deficiency (abnormal red cell turnover) the diagnosis of diabetes should be done based on glucose criteria exclusively.
- Glycation rates differ with race. A recent epidemiological study [1] found higher HbA1c rates in African American population than whites for matched levels of fasting blood glucose. However this population was also found to have higher rates of fructosamine and glycated albumin along with lower 1,5 anhydroglucitol which was concordant with the higher HbA1c levels. Further, racial differences in the rates of hemoglobin glycation and erythrocyte turnover was not enough to explain the higher HbA1c levels. Differences in post-prandial glucose levels in different races is controversial and warrants further studies.
American Diabetes Association Diabetes Diagnostic Criteria 2017 (DO NOT EDIT)[2]
Criteria for the diagnosis of diabetes |
---|
FPG ≥126 mg/dL (7.0 mmol/L). Fasting is defined as no caloric intake for at least 8 hours. |
OR |
2-hour Plasma Glucose (PG) ≥200 mg/dL (11.1 mmol/L) during an OGTT. The test should be performed as described
by the WHO, using a glucose load containing the equivalent of 75 g anhydrous glucose dissolved in water. |
OR |
A1C ≥6.5% (48 mmol/mol). |
OR |
In a patient with classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma glucose ≥200 mg/dL (11.1 mmol/L). |
The abnormal test should be repeated to rule out laboratory error, unless the diagnosis of diabetes is evident from the clinical presentation. The same test should be preferably repeated to confirm the diagnosis. If two different tests show a discordant result, then the test with abnormal result should be preferably repeated and diagnosis be made based on the results of that particular test. For example, if a patient has a normal fasting blood glucose and two abnormal HbA1c's, then the diagnosis of diabetes can be confirmed based on the two abnormal HbA1c's.
- Most of the patients with higher variability in their tests for diagnosing diabetes, have borderline abnormal results on repeat testing. Such patients may be followed up in 3 to 6 months for repeat testing.
Impaired Glucose Tests/Pre-Diabetes
- In 1997 and 2003, the International Expert Committee on Diagnosis and Classification of diabetes mellitus recognized an intermediate group of patients who did not meet the diagnostic criteria for diabetes mellitus and at the same time had a borderline abnormal glucose test result. These individuals were termed as "prediabetics".
- The patients with impaired fasting glucose have higher risks of developing diabetes and cardiovascular disease.
- The glucose level used to diagnose impaired glucose tests are:
Categories of increased risk for diabetes (prediabetes) |
---|
FPG 100 mg/dL (5.6 mmol/L) to 125 mg/dL (6.9 mmol/L) (IFG) |
OR |
2-hour PG in the 75-g OGTT 140 mg/dL (7.8 mmol/L) to 199 mg/dL (11.0 mmol/L) (IGT) |
OR |
A1C 5.726.4% (39247 mmol/mol) |
References
- ↑ Elizabeth Selvin, Michael W. Steffes, Christie M. Ballantyne, Ron C. Hoogeveen, Josef Coresh & Frederick L. Brancati (2011). "Racial differences in glycemic markers: a cross-sectional analysis of community-based data". Annals of internal medicine. 154 (5): 303–309. doi:10.7326/0003-4819-154-5-201103010-00004. PMID 21357907. Unknown parameter
|month=
ignored (help) - ↑ "Standards of Medical Care in Diabetes-2017: Summary of Revisions". Diabetes Care. 40 (Suppl 1): S4–S5. 2017. doi:10.2337/dc17-S003. PMID 27979887.