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{{Diabetes mellitus type 2}}
{{Diabetes mellitus type 2}}
{{CMG}}; {{AE}}{{MehdiP}}


{{Diabetes mellitus }}
==Overview==
[[Diabetes]] [[Screening (medicine)|screening]] is recommended for many people at various stages of life, and for those with [[Risk factor|risk factors]]. [[Screening (medicine)|Screening]] tests are the same tests used for diagnosis. [[American Diabetes Association]] recommends [[Screening (medicine)|screening]] starting at the age of 45 years in patients with risk factors. Moreover, there are [[Screening (medicine)|screening]] strategies for women with history of [[gestational diabetes]], in order to address higher chance of [[Diabetes mellitus type 2|type 2 diabetes]] development in this specific population. Early diagnosis and treatment can control the [[Complication (medicine)|complications]] and result in better clinical outcomes.
 
== Screening ==
 
* [[Screening (medicine)|Screening]] is recommended for persons at risk of developing [[diabetes]], starting at the age 45 years.
 
===American Diabetes Association===
The ADA updated their screening recommendations in 2022<ref name="pmid34964875">{{cite journal| author=American Diabetes Association Professional Practice Committee. American Diabetes Association Professional Practice Committee:. Draznin B, Aroda VR, Bakris G, Benson G | display-authors=etal| title=2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2022. | journal=Diabetes Care | year= 2022 | volume= 45 | issue= Supplement_1 | pages= S17-S38 | pmid=34964875 | doi=10.2337/dc22-S002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34964875  }} </ref>.
 
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
!align="center" style="background:#DCDCDC;"|'''ADA criteria for testing for diabetes or prediabetes in asymptomatic adults'''<ref name="pmid34964875"/>
|-
|align="left" style="background:#F5F5F5;"|
2.7 Screening for prediabetes and type 2 diabetes with an informal assessment of risk factors or validated risk calculator should be done in asymptomatic adults. B
 
2.8 Testing for prediabetes and/or type 2 diabetes in asymptomatic people should be considered in adults of any age with overweight or obesity (BMI ≥25 kg/m2 or ≥23 kg/m2 in Asian Americans) who have one or more risk factors (Table 2.3). B


{{CMG}}; '''Associate Editor(s)-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, M.B.B.S.]] [mailto:psingh@perfuse.org]; {{CZ}}
2.9 For all people, screening should begin at age 35 years. B


==Overview==
2.10 If tests are normal, repeat screening recommended at a minimum of 3-year intervals is reasonable, sooner with symptoms or change in risk (i.e., weight gain). C


==Screening and prevention==
2.11 To screen for prediabetes and type 2 diabetes, fasting plasma glucose, 2-h plasma glucose during 75-g oral glucose tolerance test, and A1C are each appropriate
Interest has arisen in preventing diabetes due to research on the benefits of treating patients before overt diabetes. Although the [http://www.ahrq.gov/clinic/uspstfix.htm U.S. Preventive Services Task Force (USPSTF)] concluded that "the evidence is insufficient to recommend for or against routinely screening asymptomatic adults for type 2 diabetes, impaired glucose tolerance, or impaired fasting glucose"<ref name="pmid12558361">{{cite journal |author=U.S. Preventive Services Task Force |title=Screening for type 2 diabetes mellitus in adults: recommendations and rationale |journal=Ann. Intern. Med. |volume=138 |issue=3 |pages=212-4 |year=2003 |pmid=12558361 |url=http://www.annals.org/cgi/content/full/138/3/212}}  [http://www.ngc.gov/summary/summary.aspx?ss=15&doc_id=3523 National Guidelines Clearinghouse: Complete Summary]</ref><ref name="pmid12558362">{{cite journal |author=Harris R, Donahue K, Rathore SS, Frame P, Woolf SH, Lohr KN |title=Screening adults for type 2 diabetes: a review of the evidence for the U.S. Preventive Services Task Force |journal=Ann. Intern. Med. |volume=138 |issue=3 |pages=215-29 |year=2003 |pmid=12558362|url=http://www.annals.org/cgi/content/full/138/3/215}}</ref>, this was a [http://www.ahrq.gov/clinic/3rduspstf/ratings.htm grade I recommendation] when published in 2003. However, the USPSTF does recommend screening for diabetics in adults with hypertension or hyperlipidemia ([http://www.ahrq.gov/clinic/3rduspstf/ratings.htm grade B recommendation]).
|}


In 2005, an [http://www.ahrq.gov/clinic/epcindex.htm evidence report] by the [[Agency for Healthcare Research and Quality]] concluded that "there is evidence that combined diet and exercise, as well as drug therapy (metformin, acarbose), may be effective at preventing progression to DM in IGT subjects".<ref name="pmid16194123">{{cite journal |author=Santaguida PL, Balion C, Hunt D, ''et al'' |title=Diagnosis, prognosis, and treatment of impaired glucose tolerance and impaired fasting glucose |journal=Evidence report/technology assessment (Summary) |volume= |issue=128 |pages=1-11 |year=2005 |pmid=16194123 |doi= | url=http://www.ahrq.gov/clinic/epcsums/impglusum.htm}}</ref>
===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 [[Diabetes mellitus type 2|T2DM]] [[postpartum]].<ref name="pmid16333011">{{cite journal| author=Kaaja RJ, Greer IA| title=Manifestations of chronic disease during pregnancy. | journal=JAMA | year= 2005 | volume= 294 | issue= 21 | pages= 2751-7 | pmid=16333011 | doi=10.1001/jama.294.21.2751 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16333011  }} </ref><ref name="pmid15765129">{{cite journal| author=Buchanan TA, Xiang AH| title=Gestational diabetes mellitus. | journal=J Clin Invest | year= 2005 | volume= 115 | issue= 3 | pages= 485-91 | pmid=15765129 | doi=10.1172/JCI24531 | pmc=PMC1052018 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15765129 }} </ref><ref name="pmid17138780">{{cite journal| author=Russell MA, Phipps MG, Olson CL, Welch HG, Carpenter MW| title=Rates of postpartum glucose testing after gestational diabetes mellitus. | journal=Obstet Gynecol | year= 2006 | volume= 108 | issue= 6 | pages= 1456-62 | pmid=17138780 | doi=10.1097/01.AOG.0000245446.85868.73 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17138780  }} </ref><ref name="pmid12351492">{{cite journal| author=Kim C, Newton KM, Knopp RH| title=Gestational diabetes and the incidence of type 2 diabetes: a systematic review. | journal=Diabetes Care | year= 2002 | volume= 25 | issue= 10 | pages= 1862-8 | pmid=12351492 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12351492  }} </ref><ref name="pmid20636958">{{cite journal| author=Chodick G, Elchalal U, Sella T, Heymann AD, Porath A, Kokia E et al.| title=The risk of overt diabetes mellitus among women with gestational diabetes: a population-based study. | journal=Diabet Med | year= 2010 | volume= 27 | issue= 7 | pages= 779-85 | pmid=20636958 | doi=10.1111/j.1464-5491.2010.02995.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20636958  }} </ref> Consequently, ACOG guidelines currently recommend the following [[Screening (medicine)|screening]] methods for [[Diabetes mellitus type 2|T2DM]] detection:
* 75g 2-hr [[oral glucose tolerance test]] ([[Glucose tolerance test|OGTT]])
'''OR'''
* [[Fasting plasma glucose]] at 6-12 weeks [[postpartum]]


===Accuracy of tests for early detection===
===Fifth International Workshop-Conference on GDM & American Diabetic Association===
If a 2-hour postload glucose level of at least 11.1 mmol/L (≥ 200 mg/dL) is used as the reference standard, the fasting plasma glucose > 7.0 mmol/L (126 mg/dL) diagnoses ''current'' diabetes with<ref name="pmid12558362"/>:
Data has been presented that estimates only 34% of women with [[Impaired glucose tolerance|IGT]] or [[Diabetes mellitus type 2|type 2 diabetes]] had impaired fasting [[glucose]] and that 44% of those with [[Diabetes mellitus type 2|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 (medicine)|screening]] result, [[Gestational diabetes|GDM]]-diagnosed mothers ought to undergo the following [[Screening (medicine)|screening]] strategy<ref name="pmid26696688">{{cite journal| author=American Diabetes Association| title=12. Management of Diabetes in Pregnancy. | journal=Diabetes Care | year= 2016 | volume= 39 Suppl 1 | issue=  | pages= S94-8 | pmid=26696688 | doi=10.2337/dc16-S015 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26696688  }} </ref><ref name="pmid17596481">{{cite journal| author=Metzger BE, Buchanan TA, Coustan DR, de Leiva A, Dunger DB, Hadden DR et al.| title=Summary and recommendations of the Fifth International Workshop-Conference on Gestational Diabetes Mellitus. | journal=Diabetes Care | year= 2007 | volume= 30 Suppl 2 | issue=  | pages= S251-60 | pmid=17596481 | doi=10.2337/dc07-s225 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17596481  }} </ref>:
* [[sensitivity (tests)|sensitivity]] about 50%
* [[specificity (tests)|specificity]] greater than 95%


A ''random'' capillary blood glucose > 6.7 mmol/L (120 mg/dL) diagnoses ''current'' diabetes with<ref name="pmid11679454">{{cite journal |author=Rolka DB, Narayan KM, Thompson TJ, ''et al'' |title=Performance of recommended screening tests for undiagnosed diabetes and dysglycemia |journal=Diabetes Care |volume=24 |issue=11 |pages=1899-903 |year=2001 |pmid=11679454 |doi=}}</ref>:
* Post-[[Childbirth|delivery]] (1–3 days): Fasting or random plasma [[glucose]]
* [[sensitivity (tests)|sensitivity]] = 75%
* Early [[Postnatal|postpartum]] (6-12 weeks [[Postnatal|postpartum]]): 75-g 2-h [[Glucose tolerance test|OGTT]]
* [[specificity (tests)|specificity]] = 88%
* 1 year postpartum: 75-g 2-h OGTT
* Annually: Fasting plasma [[glucose]]
* Tri-annually: 75-g 2-h [[Glucose tolerance test|OGTT]]
* Prepregnancy: 75-g 2-h [[Glucose tolerance test|OGTT]]


[[Glycosylated hemoglobin]] values that are elevated (over 5%), but not in the diabetic range (not over 7.0%) are predictive of ''subsequent'' clinical diabetes in US female health professionals.<ref name="pmid17679132">{{cite journal |author=Pradhan AD, Rifai N, Buring JE, Ridker PM |title=Hemoglobin A1c predicts diabetes but not cardiovascular disease in nondiabetic women |journal=Am. J. Med. |volume=120 |issue=8 |pages=720-7 |year=2007 |pmid=17679132 |doi=10.1016/j.amjmed.2007.03.022}}</ref> In this study, 177 of 1061 patients with [[glycosylated hemoglobin]] value less than 6% became diabetic within 5 years compared to 282 of 26281 patients with a [[glycosylated hemoglobin]] value of 6.0% or more. This equates to a [[glycosylated hemoglobin]] value of 6.0% or more having:
===Benefit of Early Detection===
* [[sensitivity (tests)|sensitivity]] = 16.7%
* [[specificity (tests)|specificity]] = 98.9%


===Benefit of early detection===
* Following the publication of the [[United states preventive services task force recommendations scheme|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 40 kg/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>.
Since publication of the USPSTF statement, a [[randomized controlled trial]] of prescribing [[acarbose]] to patients with "high-risk population of men and women between the ages of 40 and 70 years with a body mass index (BMI), calculated as weight in kilograms divided by the square of height in meters, between 25 and 40. 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) found 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==
{{reflist|2}}
{{Reflist|2}}
{{WH}}
{{WS}}


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Latest revision as of 14:54, 28 January 2022

Diabetes mellitus main page

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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 risk factors. Screening tests are the same tests used for diagnosis. American Diabetes Association recommends screening starting at the age of 45 years in patients with risk factors. Moreover, there are screening strategies for women with history of gestational diabetes, in order to address higher chance of type 2 diabetes development in this specific population. 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

The ADA updated their screening recommendations in 2022[1].

ADA criteria for testing for diabetes or prediabetes in asymptomatic adults[1]

2.7 Screening for prediabetes and type 2 diabetes with an informal assessment of risk factors or validated risk calculator should be done in asymptomatic adults. B

2.8 Testing for prediabetes and/or type 2 diabetes in asymptomatic people should be considered in adults of any age with overweight or obesity (BMI ≥25 kg/m2 or ≥23 kg/m2 in Asian Americans) who have one or more risk factors (Table 2.3). B

2.9 For all people, screening should begin at age 35 years. B

2.10 If tests are normal, repeat screening recommended at a minimum of 3-year intervals is reasonable, sooner with symptoms or change in risk (i.e., weight gain). C

2.11 To screen for prediabetes and type 2 diabetes, fasting plasma glucose, 2-h plasma glucose during 75-g oral glucose tolerance test, and A1C are each appropriate

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.[2][3][4][5][6] 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[7][8]:

Benefit of Early Detection

References

  1. ↑ 1.0 1.1 American Diabetes Association Professional Practice Committee. American Diabetes Association Professional Practice Committee:. Draznin B, Aroda VR, Bakris G, Benson G; et al. (2022). "2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2022". Diabetes Care. 45 (Supplement_1): S17–S38. doi:10.2337/dc22-S002. PMID 34964875 Check |pmid= value (help).
  2. ↑ 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.
  3. ↑ Buchanan TA, Xiang AH (2005). "Gestational diabetes mellitus". J Clin Invest. 115 (3): 485–91. doi:10.1172/JCI24531. PMC 1052018. PMID 15765129.
  4. ↑ 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.
  5. ↑ 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.
  6. ↑ 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.
  7. ↑ American Diabetes Association (2016). "12. Management of Diabetes in Pregnancy". Diabetes Care. 39 Suppl 1: S94–8. doi:10.2337/dc16-S015. PMID 26696688.
  8. ↑ 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.
  9. ↑ 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
  10. ↑ 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
  11. ↑ 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

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