Difference between revisions of "Diabetes mellitus type 2 screening"

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==Overview==
 
==Overview==
Diabetes screening is recommended for many people at various stages of life, and for those with any of several risk factors. Screening tests are the same tests used for diagnosis. Early diagnosis and treatment can control the complications and result in better clinical outcomes.
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[[Diabetes]] [[Screening (medicine)|screening]] is recommended for many people at various stages of life, and for those with any of several [[Risk factor|risk factors]]. Screening tests are the same tests used for diagnosis. Early diagnosis and treatment can control the [[Complication (medicine)|complications]] and result in better clinical outcomes.
  
 
== Screening ==
 
== Screening ==
Screening is recommended for persons at risk of developing diabetes, starting at  the age 45 years.
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[[Screening (medicine)|Screening]] is recommended for persons at risk of developing [[diabetes]], starting at  the age 45 years.
 
===American Diabetes Association===
 
===American Diabetes Association===
  
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Following the publication of the USPSTF statement, a [[randomized controlled trial]] was done and [[acarbose]] was prescribed to patients in the "high-risk population" between the ages of 40 and 70 years, whose body mass index (calculated as weight in kilograms divided by the square of height in meters) fell between 25 and 40kg/m<sup>2</sup>. They were eligible for the study if they had [[Impaired glucose tolerance|IGT]] according to the [[World Health Organization]] criteria, plus [[impaired fasting glucose]] (a fasting plasma glucose concentration of between ''100'' and 140 mg/dL or 5.5 and 7.8 mmol/L). The trial revealed a [[number needed to treat]] of  44 (over 3.3 years) to prevent a major cardiovascular event<ref name="pmid12876091">{{cite journal |author=Chiasson JL, Josse RG, Gomis R, Hanefeld M, Karasik A, Laakso M |title=Acarbose treatment and the risk of cardiovascular disease and hypertension in patients with impaired glucose tolerance: the STOP-NIDDM trial |journal=JAMA |volume=290 |issue=4 |pages=486-94 |year=2003 |pmid=12876091 |doi=10.1001/jama.290.4.486}} [http://www.acpjc.org/Content/140/1/issue/ACPJC-2004-140-1-002.htm ACP Journal Club review]</ref>.
 
Following the publication of the USPSTF statement, a [[randomized controlled trial]] was done and [[acarbose]] was prescribed to patients in the "high-risk population" between the ages of 40 and 70 years, whose body mass index (calculated as weight in kilograms divided by the square of height in meters) fell between 25 and 40kg/m<sup>2</sup>. They were eligible for the study if they had [[Impaired glucose tolerance|IGT]] according to the [[World Health Organization]] criteria, plus [[impaired fasting glucose]] (a fasting plasma glucose concentration of between ''100'' and 140 mg/dL or 5.5 and 7.8 mmol/L). The trial revealed a [[number needed to treat]] of  44 (over 3.3 years) to prevent a major cardiovascular event<ref name="pmid12876091">{{cite journal |author=Chiasson JL, Josse RG, Gomis R, Hanefeld M, Karasik A, Laakso M |title=Acarbose treatment and the risk of cardiovascular disease and hypertension in patients with impaired glucose tolerance: the STOP-NIDDM trial |journal=JAMA |volume=290 |issue=4 |pages=486-94 |year=2003 |pmid=12876091 |doi=10.1001/jama.290.4.486}} [http://www.acpjc.org/Content/140/1/issue/ACPJC-2004-140-1-002.htm ACP Journal Club review]</ref>.
  
Other studies have shown that life-style changes<ref name="pmid17098085">{{cite journal |author=Lindström J, Ilanne-Parikka P, Peltonen M, Aunola S, Eriksson JG, Hemiö K, Hämäläinen H, Härkönen P, Keinänen-Kiukaanniemi S, Laakso M, Louheranta A, Mannelin M, Paturi M, Sundvall J, Valle TT, Uusitupa M, Tuomilehto J |title=Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study |journal=Lancet |volume=368 |issue=9548 |pages=1673-9 |year=2006 |pmid=17098085|doi=10.1016/S0140-6736(06)69701-8}}[http://www.acpjc.org/Content/146/2/issue/ACPJC-2007-146-2-037.htm ACP Journal Club review]</ref> and [[metformin]]<ref name="pmid11832527">{{cite journal |author=Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM |title=Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin |journal=N. Engl. J. Med. |volume=346 |issue=6 |pages=393-403 |year=2002 |pmid=11832527|doi=10.1056/NEJMoa012512}} [http://www.acpjc.org/Content/137/2/issue/ACPJC-2002-137-2-055.htm ACP Journal Club review]</ref> can delay the onset of diabetes.
+
Other studies have shown that life-style changes<ref name="pmid17098085">{{cite journal |author=Lindström J, Ilanne-Parikka P, Peltonen M, Aunola S, Eriksson JG, Hemiö K, Hämäläinen H, Härkönen P, Keinänen-Kiukaanniemi S, Laakso M, Louheranta A, Mannelin M, Paturi M, Sundvall J, Valle TT, Uusitupa M, Tuomilehto J |title=Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study |journal=Lancet |volume=368 |issue=9548 |pages=1673-9 |year=2006 |pmid=17098085|doi=10.1016/S0140-6736(06)69701-8}}[http://www.acpjc.org/Content/146/2/issue/ACPJC-2007-146-2-037.htm ACP Journal Club review]</ref> and [[metformin]]<ref name="pmid11832527">{{cite journal |author=Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM |title=Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin |journal=N. Engl. J. Med. |volume=346 |issue=6 |pages=393-403 |year=2002 |pmid=11832527|doi=10.1056/NEJMoa012512}} [http://www.acpjc.org/Content/137/2/issue/ACPJC-2002-137-2-055.htm ACP Journal Club review]</ref> can delay the onset of diabetes.
  
 
==References==
 
==References==

Revision as of 19:34, 2 August 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]

Overview

Diabetes screening is recommended for many people at various stages of life, and for those with any of several risk factors. Screening tests are the same tests used for diagnosis. Early diagnosis and treatment can control the complications and result in better clinical outcomes.

Screening

Screening is recommended for persons at risk of developing diabetes, starting at the age 45 years.

American Diabetes Association

Criteria for testing for diabetes or prediabetes in asymptomatic adults
Testing should be considered in overweight or obese (BMI ≥25 kg/m2 or ≥23 kg/m2 in Asian Americans) adults who have one or more of the following risk factors:
  • A1C  ≥5.7% (39 mmol/mol), IGT, or IFG on previous testing
  • First-degree relative with diabetes
  • High-risk race/ethnicity (e.g., African American, Latino, Native American, Asian American, Pacific Islander)
  • Women who were diagnosed with GDM
  • History of CVD
  • Hypertension ( ≥140/90 mmHg or on therapy for hypertension)
  • HDL cholesterol level <35 mg/dL (0.90 mmol/L) and/or a triglyceride level >250 mg/dL (2.82 mmol/L)
  • Women with polycystic ovary syndrome
  • Physical inactivity
  • Other clinical conditions associated with insulin resistance (e.g., severe obesity, acanthosis nigricans).
For patients at risk, testing should begin at the age of 45 years.
If results are normal, testing should be repeated at a minimum of 3-year intervals, with consideration of more frequent testing depending on initial results (e.g., those with

prediabetes should be tested yearly) and risk status.

To decrease the risk of developing type 2 diabetes in pregnant women after pregnancy, they should be screened for early detection of diabetes according to the following guidelines:

American College of Obstetricians and Gynecologists (ACOG)

It has been estimated that 15-50% of gestational diabetes mellitus-diagnosed mothers will go on to develop T2DM postpartum.[1][2][3][4][5] Consequently, ACOG guidelines currently recommend the following screening methods for T2DM detection:

OR

Fifth International Workshop-Conference on GDM & American Diabetic Association

Data has been presented that estimates only 34% of women with IGT or type 2 diabetes had impaired fasting glucose and that 44% of those with type 2 diabetes had fasting levels 100 mg/day (5.5 mmol/l) during their postpartum visit. Given this risk, it has been suggested by this symposium in conjunction with the ADA that regardless of the 6-12 week screening result, GDM-diagnosed mothers ought to undergo the following screening strategy[6][7]:

  • Post-delivery (1–3 days): Fasting or random plasma glucose
  • Early postpartum (6-12 weeks postpartum): 75-g 2-h OGTT
  • 1 year postpartum: 75-g 2-h OGTT
  • Annually: Fasting plasma glucose
  • Tri-annually: 75-g 2-h OGTT
  • Prepregnancy: 75-g 2-h OGTT

Benefit of Early Detection

Following the publication of the USPSTF statement, a randomized controlled trial was done and acarbose was prescribed to patients in the "high-risk population" between the ages of 40 and 70 years, whose body mass index (calculated as weight in kilograms divided by the square of height in meters) fell between 25 and 40kg/m2. They were eligible for the study if they had IGT according to the World Health Organization criteria, plus impaired fasting glucose (a fasting plasma glucose concentration of between 100 and 140 mg/dL or 5.5 and 7.8 mmol/L). The trial revealed a number needed to treat of 44 (over 3.3 years) to prevent a major cardiovascular event[8].

Other studies have shown that life-style changes[9] and metformin[10] can delay the onset of diabetes.

References

  1. Kaaja RJ, Greer IA (2005). "Manifestations of chronic disease during pregnancy". JAMA. 294 (21): 2751–7. doi:10.1001/jama.294.21.2751. PMID 16333011.
  2. Buchanan TA, Xiang AH (2005). "Gestational diabetes mellitus". J Clin Invest. 115 (3): 485–91. doi:10.1172/JCI24531. PMC 1052018. PMID 15765129.
  3. Russell MA, Phipps MG, Olson CL, Welch HG, Carpenter MW (2006). "Rates of postpartum glucose testing after gestational diabetes mellitus". Obstet Gynecol. 108 (6): 1456–62. doi:10.1097/01.AOG.0000245446.85868.73. PMID 17138780.
  4. Kim C, Newton KM, Knopp RH (2002). "Gestational diabetes and the incidence of type 2 diabetes: a systematic review". Diabetes Care. 25 (10): 1862–8. PMID 12351492.
  5. Chodick G, Elchalal U, Sella T, Heymann AD, Porath A, Kokia E; et al. (2010). "The risk of overt diabetes mellitus among women with gestational diabetes: a population-based study". Diabet Med. 27 (7): 779–85. doi:10.1111/j.1464-5491.2010.02995.x. PMID 20636958.
  6. American Diabetes Association (2016). "12. Management of Diabetes in Pregnancy". Diabetes Care. 39 Suppl 1: S94–8. doi:10.2337/dc16-S015. PMID 26696688.
  7. Metzger BE, Buchanan TA, Coustan DR, de Leiva A, Dunger DB, Hadden DR; et al. (2007). "Summary and recommendations of the Fifth International Workshop-Conference on Gestational Diabetes Mellitus". Diabetes Care. 30 Suppl 2: S251–60. doi:10.2337/dc07-s225. PMID 17596481.
  8. Chiasson JL, Josse RG, Gomis R, Hanefeld M, Karasik A, Laakso M (2003). "Acarbose treatment and the risk of cardiovascular disease and hypertension in patients with impaired glucose tolerance: the STOP-NIDDM trial". JAMA. 290 (4): 486–94. doi:10.1001/jama.290.4.486. PMID 12876091. ACP Journal Club review
  9. Lindström J, Ilanne-Parikka P, Peltonen M, Aunola S, Eriksson JG, Hemiö K, Hämäläinen H, Härkönen P, Keinänen-Kiukaanniemi S, Laakso M, Louheranta A, Mannelin M, Paturi M, Sundvall J, Valle TT, Uusitupa M, Tuomilehto J (2006). "Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study". Lancet. 368 (9548): 1673–9. doi:10.1016/S0140-6736(06)69701-8. PMID 17098085.ACP Journal Club review
  10. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM (2002). "Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin". N. Engl. J. Med. 346 (6): 393–403. doi:10.1056/NEJMoa012512. PMID 11832527. ACP Journal Club review