Lab

Diabetes Screening

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Diabetes Screening, Diabetes Mellitus Screen, Type II Diabetes Screening, Diabetes Mellitus Diagnostic Criteria

  • Precautions
  1. Type II Diabetes Screening guidelines vary by organization (e.g. ADA, USPTF, AAFP, ACOG, AAP)
    1. Early detection of Prediabetes may delay development of Type II Diabetes Mellitus
    2. However, Type II Diabetes detection does not alter mortality within first 10-20 years
    3. Screening for Type II Diabetes in age >70 years should be individualized based on life-expectancy and quality of life
  2. Routine screening for Type I Diabetes is not recommended
    1. Type I Diabetes presents with acute onset of symptoms (contrast with often asymptomatic Type II)
    2. Type I Antibody tests (e.g. GAD-65, C-peptide) do not have established cut-off values
    3. No established management strategy for asymptomatic Type I Diabetes prior to Hyperglycemia
  • Indications
  • Diabetes Screening in children (every 2 years starting at age 10 years or Puberty)
  1. See Type 2 Diabetes Mellitus in Children
  2. BMI or weight over 85% or more than 120% over Ideal Weight
  3. Two of the following risk factors
    1. Family History of diabetes in first or second degree relative
    2. High risk ethnicity (black, native american, native alaskan, asian, hispanic, pacific islander or native hawaiian)
    3. Signs or symptoms of Insulin Resistance
      1. Acanthosis Nigricans
      2. Hypertension
      3. Dyslipidemia (especially elevated Triglycerides, HDL Cholesterol)
      4. Polycystic ovarian disease
  • Indications
  • Diabetes Screening in adults (every 3 years starting at age 45 years, every 1 year for high risk patients)
  1. Screen if Body Mass Index (BMI) >25 and one additional risk factor below
  2. Age 40 to 70 years old
  3. Physical inactivity
  4. Family History of diabetes (especially first degree relative)
  5. High risk ethnicity (black, native american, native alaskan, asian, hispanic, pacific islander or native hawaiian)
  6. Prior Gestational Diabetes mellitus (or newborn >9 pounds)
  7. Hypertension
  8. Cardiovascular disease history
  9. Dyslipidemia
    1. HDL Cholesterol <35 and
    2. Serum Triglycerides >250 mg/dl
  10. History of Impaired Glucose Tolerance
  11. Polycystic ovarian syndrome (PCOS)
  12. Clinical findings suggestive of Diabetes Mellitus (e.g. Acanthosis Nigricans)
  • Indications
  • Pregnancy
  1. Universal screening after 24 weeks gestation in all pregnant women (see Gestational Diabetes)
  2. First trimester Gestational Diabetes indications (ACOG, ADA)
    1. Type II Diabetes Mellitus risk factors
    2. Obesity
    3. Advanced maternal age >35 years old
    4. Prior history of Gestational Diabetes
    5. High risk ethnicity (black, native american, native alaskan, asian, hispanic, pacific islander or native hawaiian)
  • Interpretation
  • Findings suggestive of Diabetes Mellitus (two of the following, or repeat testing)
  1. See Diabetes Mellitus
  2. Random Serum Glucose
    1. Serum Glucose over 200 mg/dl with symptoms
  3. Fasting Serum Glucose
    1. Serum Glucose exceeds 126 mg/dl on 2 different days
  4. Postprandial Glucose (2 hours post meal)
    1. Serum Glucose over 200 mg/dl
    2. Precedes Fasting Glucose increase
    3. More predictive of Diabetes Mellitus Complications
  5. Casual Plasma Glucose (random Glucose)
    1. Same criteria as postprandial Glucose
  6. Oral Glucose Tolerance Test (OGGT)
    1. Two hour Glucose Tolerance Test (75 gram) >200 mg/dl
    2. Consider in patients with Insulin Resistance
      1. Patients with pre-diabetes to qualify for education
  7. Hemoglobin A1C
    1. Hemoglobin A1C >6.5%
  1. See Prediabetes
  2. Hemoglobin A1C 5.7 to 6.4%
  3. Fasting Glucose: 100 to 125 mg/dl
    1. Known as Impaired Fasting Glucose
    2. New guidelines suggest bottom cut-off of 100 mg/dl
    3. Metabolic Syndrome defined as 110 mg/dl or higher
  4. Two hour Glucose Tolerance Test (75 g): 140-199 mg/dl
    1. Known as Impaired Glucose Tolerance
  • References
  1. Vail (2012) AAFP Board Review Express, San Jose
  2. Pippitt (2016) Am Fam Physician 93(2): 103-9 [PubMed]