Classification and Diagnosis of Diabetes: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{ADA guidelines}} | {{ADA guidelines}} | ||
{{CMG}} {{AE}} {{SCh | {{CMG}} {{AE}} {{SCh}}; {{TarekNafee}} | ||
==2016 ADA Standards of Medical Care in Diabetes Guidelines== | ==2016 ADA Standards of Medical Care in Diabetes Guidelines<ref name="urlcare.diabetesjournals.org">{{cite web |url=http://care.diabetesjournals.org/content/suppl/2015/12/21/39.Supplement_1.DC2/2016-Standards-of-Care.pdf |title=care.diabetesjournals.org |format= |work= |accessdate=}}</ref>== | ||
===Categories of Increased risk for diabetes (PREDIABETES)=== | ===Categories of Increased risk for diabetes (PREDIABETES)=== | ||
{|class="wikitable" | {|class="wikitable" | ||
| bgcolor="Seashell"|<nowiki>"</nowiki>'''1.''' Testing to assess risk for future | | bgcolor="Seashell"|<nowiki>"</nowiki>'''1.''' Testing to assess risk for future diabetes in asymptomatic people should be considered in adults of any age who are overweight or obese (BMI ≥ 25 kg/m2 or ≥ 23 kg/m2 in Asian Americans) and who have one or more additional risk factors for diabetes. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: B]])''<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="Seashell"|<nowiki>"</nowiki>'''2.''' For all patients, testing should begin at age 45 years ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: B]])''<nowiki>"</nowiki> | | bgcolor="Seashell"|<nowiki>"</nowiki>'''2.''' For all patients, testing should begin at age 45 years ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: B]])''<nowiki>"</nowiki> | ||
| Line 13: | Line 13: | ||
| bgcolor="Seashell"|<nowiki>"</nowiki>'''4.''' To test for prediabetes, fasting plasma glucose, 2-h plasma glucose after 75-g oral glucose tolerance test, and A1C are equally appropriate. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: B]])''<nowiki>"</nowiki> | | bgcolor="Seashell"|<nowiki>"</nowiki>'''4.''' To test for prediabetes, fasting plasma glucose, 2-h plasma glucose after 75-g oral glucose tolerance test, and A1C are equally appropriate. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: B]])''<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="Seashell"|<nowiki>"</nowiki>'''5.''' In patients with prediabetes, | | bgcolor="Seashell"|<nowiki>"</nowiki>'''5.''' In patients with prediabetes, identify and, if appropriate, treat other cardiovascular disease risk factors. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: B]])''<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="Seashell"|<nowiki>"</nowiki>'''6.''' Testing to detect prediabetes should be considered in children and | | bgcolor="Seashell"|<nowiki>"</nowiki>'''6.''' Testing to detect prediabetes should be considered in children and adolescents who are overweight or obese and who have two or more additional risk factors for diabetes ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: E]])''<nowiki>"</nowiki> | ||
|- | |- | ||
| Line 31: | Line 31: | ||
===TYPE 2 DIABETES=== | ===TYPE 2 DIABETES=== | ||
{|class="wikitable" | {|class="wikitable" | ||
| bgcolor="Seashell"|<nowiki>"</nowiki>'''1.''' Testing to detect type 2 diabetes in asymptomatic people should be | | bgcolor="Seashell"|<nowiki>"</nowiki>'''1.''' Testing to detect type 2 diabetes in asymptomatic people should be considered in adults of any age who are overweight or obese (BMI ≥25 kg/m2 or ≥23 kg/m2 in Asian Americans) and who have one or more additional risk factors for diabetes. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: B]])''<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="Seashell"|<nowiki>"</nowiki>'''2.''' For all patients, testing should | | bgcolor="Seashell"|<nowiki>"</nowiki>'''2.''' For all patients, testing should begin at age 45 years. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: B]])''<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="Seashell"|<nowiki>"</nowiki>'''3.''' If tests are normal, repeat testing carried out at a minimum of 3-year intervals is reasonable. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: C]])''<nowiki>"</nowiki> | | bgcolor="Seashell"|<nowiki>"</nowiki>'''3.''' If tests are normal, repeat testing carried out at a minimum of 3-year intervals is reasonable. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: C]])''<nowiki>"</nowiki> | ||
| Line 41: | Line 41: | ||
| bgcolor="Seashell"|<nowiki>"</nowiki>'''5.''' In patients with diabetes, identify and, if appropriate, treat other cardiovascular disease risk factors. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: B]])''<nowiki>"</nowiki> | | bgcolor="Seashell"|<nowiki>"</nowiki>'''5.''' In patients with diabetes, identify and, if appropriate, treat other cardiovascular disease risk factors. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: B]])''<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="Seashell"|<nowiki>"</nowiki>'''6.''' Testing to detect | | bgcolor="Seashell"|<nowiki>"</nowiki>'''6.''' Testing to detect type 2 diabetes should be considered in children and adolescents who are overweight or obese and who have two or more additional risk factors for diabetes ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: E]])''<nowiki>"</nowiki> | ||
|- | |- | ||
| Line 48: | Line 48: | ||
===GESTATIONAL DIABETES MELLITUS=== | ===GESTATIONAL DIABETES MELLITUS=== | ||
{|class="wikitable" | {|class="wikitable" | ||
| bgcolor="Seashell"|<nowiki>"</nowiki>'''1.''' Test for undiagnosed type 2 | | bgcolor="Seashell"|<nowiki>"</nowiki>'''1.''' Test for undiagnosed type 2 diabetes at the first prenatal visit in those with risk factors, using standard diagnostic criteria. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: B]])''<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="Seashell"|<nowiki>"</nowiki>'''2.''' Test for gestational diabetes | | bgcolor="Seashell"|<nowiki>"</nowiki>'''2.''' Test for gestational diabetes mellitus at 24–28 weeks of gestation in pregnant women not previously known to have diabetes. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: A]])''<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="Seashell"|<nowiki>"</nowiki>'''3.''' Screen women with gestational | | bgcolor="Seashell"|<nowiki>"</nowiki>'''3.''' Screen women with gestational diabetes mellitus for persistent diabetes at 6–12 weeks postpartum,using the oral glucose tolerance test and clinically appropriate non- pregnancy diagnostic criteria. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: E]])''<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="Seashell"|<nowiki>"</nowiki>'''4.''' Women with a history of | | bgcolor="Seashell"|<nowiki>"</nowiki>'''4.''' Women with a history of gestational diabetes mellitus should have lifelong screening for the development of diabetes or prediabetes at least every 3 years. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: B]])''<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="Seashell"|<nowiki>"</nowiki>'''5.''' Women with a history of | | bgcolor="Seashell"|<nowiki>"</nowiki>'''5.''' Women with a history of gestational diabetes mellitus found to have prediabetes should receive lifestyle interventions or metformin to prevent diabetes. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: A]])''<nowiki>"</nowiki> | ||
|- | |- | ||
| Line 63: | Line 63: | ||
===MONOGENIC DIABETES SYNDROMES=== | ===MONOGENIC DIABETES SYNDROMES=== | ||
{|class="wikitable" | {|class="wikitable" | ||
| bgcolor="Seashell"|<nowiki>"</nowiki>'''1.''' All children diagnosed with | | bgcolor="Seashell"|<nowiki>"</nowiki>'''1.''' All children diagnosed with diabetes in the first 6 months of life should have genetic testing. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: B]])''<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="Seashell"|<nowiki>"</nowiki>'''2.'''Maturity-onset diabetes of the young should be considered in individuals who have mild stable fasting hyperglycemia and multiple family members with diabetes not characteristic of type 1 or type 2 diabetes''([[American Diabetes Association#Evidence Grading System|Level of Evidence: E]])''<nowiki>"</nowiki> | | bgcolor="Seashell"|<nowiki>"</nowiki>'''2.'''Maturity-onset diabetes of the young should be considered in individuals who have mild stable fasting hyperglycemia and multiple family members with diabetes not characteristic of type 1 or type 2 diabetes''([[American Diabetes Association#Evidence Grading System|Level of Evidence: E]])''<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="Seashell"|<nowiki>"</nowiki>'''3.'''Because a diagnosis of maturity- onset diabetes of the young may impact therapy and lead to | | bgcolor="Seashell"|<nowiki>"</nowiki>'''3.'''Because a diagnosis of maturity- onset diabetes of the young may impact therapy and lead to identification of other affected family members, consider referring individuals with diabetes not typical of type 1 or type 2 diabetes and occuring in successive generations (suggestive of an autosomal dom- inant pattern of inheritance) to a specialist for further evaluation. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: E]])''<nowiki>"</nowiki> | ||
|- | |- | ||
| Line 78: | Line 78: | ||
| bgcolor="Seashell"|<nowiki>"</nowiki>'''2.''' A1C as a screening test for cystic fibrosis–related diabetes is not recommended. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: B]])''<nowiki>"</nowiki> | | bgcolor="Seashell"|<nowiki>"</nowiki>'''2.''' A1C as a screening test for cystic fibrosis–related diabetes is not recommended. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: B]])''<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="Seashell"|<nowiki>"</nowiki>'''3.''' Patients with cystic fibrosis–related diabetes should be treated with insulin to attain individualized | | bgcolor="Seashell"|<nowiki>"</nowiki>'''3.''' Patients with cystic fibrosis–related diabetes should be treated with insulin to attain individualized glycemic goals. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: A]])''<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="Seashell"|<nowiki>"</nowiki>'''4.''' In patients with cystic fibrosis and impaired glucose tolerance with- out confirmed diabetes, prandial insulin therapy should be | | bgcolor="Seashell"|<nowiki>"</nowiki>'''4.''' In patients with cystic fibrosis and impaired glucose tolerance with- out confirmed diabetes, prandial insulin therapy should be considered to maintain weight. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: B]])''<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="Seashell"|<nowiki>"</nowiki>'''5.''' Beginning 5 years after the diagnosis of cystic fibrosis–related diabetes, annual monitoring for complications of diabetes is recommended. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: E]])''<nowiki>"</nowiki> | | bgcolor="Seashell"|<nowiki>"</nowiki>'''5.''' Beginning 5 years after the diagnosis of cystic fibrosis–related diabetes, annual monitoring for complications of diabetes is recommended. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: E]])''<nowiki>"</nowiki> | ||
Latest revision as of 13:52, 13 December 2016
|
2016 ADA Guideline Recommendations |
|
Types of Diabetes Mellitus |
|---|
|
2016 ADA Standard of Medical Care Guideline Recommendations |
|
Cardiovascular Disease and Risk Management |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shivani Chaparala M.B.B.S [2]; Tarek Nafee, M.D. [3]
2016 ADA Standards of Medical Care in Diabetes Guidelines[1]
Categories of Increased risk for diabetes (PREDIABETES)
| "1. Testing to assess risk for future diabetes in asymptomatic people should be considered in adults of any age who are overweight or obese (BMI ≥ 25 kg/m2 or ≥ 23 kg/m2 in Asian Americans) and who have one or more additional risk factors for diabetes. (Level of Evidence: B)" |
| "2. For all patients, testing should begin at age 45 years (Level of Evidence: B)" |
| "3. If tests are normal, repeat testing carried out at a minimum of 3-year intervals is reasonable. (Level of Evidence: C)" |
| "4. To test for prediabetes, fasting plasma glucose, 2-h plasma glucose after 75-g oral glucose tolerance test, and A1C are equally appropriate. (Level of Evidence: B)" |
| "5. In patients with prediabetes, identify and, if appropriate, treat other cardiovascular disease risk factors. (Level of Evidence: B)" |
| "6. Testing to detect prediabetes should be considered in children and adolescents who are overweight or obese and who have two or more additional risk factors for diabetes (Level of Evidence: E)" |
TYPE 1 DIABETES
| "1. Blood glucose rather than A1C should be used to diagnose acute onset of type 1 diabetes in individuals with symptoms of hyperglycemia. (Level of Evidence: E)" |
| "2. Inform the relatives of patients with type 1 diabetes of the opportunity to be tested for type 1 diabetes risk, but only in the setting of a clinical research study. (Level of Evidence:E)" |
TYPE 2 DIABETES
| "1. Testing to detect type 2 diabetes in asymptomatic people should be considered in adults of any age who are overweight or obese (BMI ≥25 kg/m2 or ≥23 kg/m2 in Asian Americans) and who have one or more additional risk factors for diabetes. (Level of Evidence: B)" |
| "2. For all patients, testing should begin at age 45 years. (Level of Evidence: B)" |
| "3. If tests are normal, repeat testing carried out at a minimum of 3-year intervals is reasonable. (Level of Evidence: C)" |
| "4. To test for type 2 diabetes, fasting plasma glucose, 2-h plasma glucose after 75-g oral glucose tolerance test, and A1C are equally appropriate. (Level of Evidence: B)" |
| "5. In patients with diabetes, identify and, if appropriate, treat other cardiovascular disease risk factors. (Level of Evidence: B)" |
| "6. Testing to detect type 2 diabetes should be considered in children and adolescents who are overweight or obese and who have two or more additional risk factors for diabetes (Level of Evidence: E)" |
GESTATIONAL DIABETES MELLITUS
| "1. Test for undiagnosed type 2 diabetes at the first prenatal visit in those with risk factors, using standard diagnostic criteria. (Level of Evidence: B)" |
| "2. Test for gestational diabetes mellitus at 24–28 weeks of gestation in pregnant women not previously known to have diabetes. (Level of Evidence: A)" |
| "3. Screen women with gestational diabetes mellitus for persistent diabetes at 6–12 weeks postpartum,using the oral glucose tolerance test and clinically appropriate non- pregnancy diagnostic criteria. (Level of Evidence: E)" |
| "4. Women with a history of gestational diabetes mellitus should have lifelong screening for the development of diabetes or prediabetes at least every 3 years. (Level of Evidence: B)" |
| "5. Women with a history of gestational diabetes mellitus found to have prediabetes should receive lifestyle interventions or metformin to prevent diabetes. (Level of Evidence: A)" |
MONOGENIC DIABETES SYNDROMES
| "1. All children diagnosed with diabetes in the first 6 months of life should have genetic testing. (Level of Evidence: B)" |
| "2.Maturity-onset diabetes of the young should be considered in individuals who have mild stable fasting hyperglycemia and multiple family members with diabetes not characteristic of type 1 or type 2 diabetes(Level of Evidence: E)" |
| "3.Because a diagnosis of maturity- onset diabetes of the young may impact therapy and lead to identification of other affected family members, consider referring individuals with diabetes not typical of type 1 or type 2 diabetes and occuring in successive generations (suggestive of an autosomal dom- inant pattern of inheritance) to a specialist for further evaluation. (Level of Evidence: E)" |
CYSTIC FIBROSIS-RELATED DIABETES
| "1. Annual screening for cystic fibrosis– related diabetes with oral glucose tolerance test should begin by age 10 years in all patients with cystic fibrosis who do not have cystic fibrosis–related diabetes. (Level of Evidence: B)" |
| "2. A1C as a screening test for cystic fibrosis–related diabetes is not recommended. (Level of Evidence: B)" |
| "3. Patients with cystic fibrosis–related diabetes should be treated with insulin to attain individualized glycemic goals. (Level of Evidence: A)" |
| "4. In patients with cystic fibrosis and impaired glucose tolerance with- out confirmed diabetes, prandial insulin therapy should be considered to maintain weight. (Level of Evidence: B)" |
| "5. Beginning 5 years after the diagnosis of cystic fibrosis–related diabetes, annual monitoring for complications of diabetes is recommended. (Level of Evidence: E)" |
References
- ↑ "care.diabetesjournals.org" (PDF).