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Diabetes Mellitus Classification and Diagnosis

Diabetes Mellitus Classification and Diagnosis. Hengameh Abdi, MD Endocrine Research Center Research Institute for Endocrine Sciences Shahid Beheshti University of Medical Sciences 28 October 2015 abdi@endocrine.ac.ir. 53%. WORLD 592 million people living with diabetes. WORLD

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Diabetes Mellitus Classification and Diagnosis

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  1. Diabetes MellitusClassification and Diagnosis Hengameh Abdi, MD Endocrine Research Center Research Institute for Endocrine Sciences Shahid Beheshti University of Medical Sciences 28 October 2015 abdi@endocrine.ac.ir

  2. 53% WORLD 592 million people living with diabetes WORLD 387 million Africa 93% Middle East and North Africa 85% South East Asia 64% South and Central America 55% Western Pacific 46% Europe 33% North America and Caribbean 30% Diabetes is a huge and growing problem…

  3. MIDDLE EAST AND NORTH AFRICA at a glance 36.8 million people have diabetes - 1 in 10 adults 3% of worldwide expenditure - USD 16.8 billion

  4. Prevalence of Diabetes in Iran: 8.64%

  5. Classification: 1. Type 1 diabetes (due to β-cell destruction, usually leading to absolute insulin deficiency) 2. Type 2 diabetes (due to a progressive insulin secretory defect on the background of insulin resistance) 3. Gestational diabetes mellitus(GDM) (diabetes diagnosed in the second or third trimester of pregnancy that is not clearly overt diabetes) 4. Specific types of diabetes due to other causes: • Monogenic diabetes syndromes (such as…) Maturity-onset diabetes of the young (MODY) Lipodystrophic syndromes Neonatal diabetes • Diseases of the exocrine pancreas (such as…) Cystic fibrosis Pancreatitis • Drug- or chemical-induced diabetes(such as…) Glucocorticoids, drugs in the treatment of HIV/AIDS or after organ transplantation

  6. Spectrum of glucose homeostasis

  7. Criteria for the diagnosis of diabetes: • A1C ≥6.5% The test should be performed in a laboratory using a method that is NGSP certified and standardized to the DCCT assay.* OR • FPG ≥126 mg/dL (7.0 mmol/L) Fasting is defined as no caloric intake for at least 8 h.* OR • 2-h 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 • In a patient with classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma glucose ≥200 mg/dL (11.1 mmol/L) *In the absence of unequivocal hyperglycemia, results should be confirmed by repeat testing. • It is recommended that the same test be repeated immediately; If two different tests (such as A1C and FPG) are both above the diagnostic threshold, this also confirms the diagnosis. NGSP: National Glycohemoglobin Standardization Program FPG: Fasting Plasma GlucoseDCCT: Diabetes Control and Complications Trial OGTT: Oral Glucose Tolerance Test

  8. Criteria for testing for diabetes or prediabetes in asymptomatic adults 1. Testing should be considered in all adults of any age who are overweight (BMI ≥25 kg/m2 or ≥23 kg/m2 in Asian Americans) and have additional risk factors: • physical inactivity • first-degree relative with diabetes • high-risk race/ethnicity (e.g., African American, Latino, Native American, Asian American, Pacific Islander) • women who delivered a baby weighing >9 lb or were diagnosed with GDM • 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 • A1C ≥5.7%, IGT, or IFG on previous testing • other clinical conditions associated with insulin resistance (e.g., severe obesity, acanthosis nigricans) • history of CVD

  9. Criteria for testing for diabetes or prediabetes in asymptomatic adults (cont…) 2. For all patients, particularly those who are overweight or obese, testing should begin at age 45 years. 3. 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.

  10. Testing for type 2 diabetes or prediabetes in asymptomatic children* • Criteria • Overweight (BMI >85th percentile for age and sex, weight for height >85th percentile, or weight >120% of ideal for height) Plus any two of the following risk factors: • Family history of type 2 diabetes in first- or second-degree relative • Race/ethnicity (Native American, African American, Latino, Asian American, Pacific Islander) • Signs of insulin resistance or conditions associated with insulin resistance (acanthosis nigricans, hypertension, dyslipidemia, polycystic ovary syndrome, or small for-gestational-age birth weight) • Maternal history of diabetes or GDM during the child’s gestation • Age of initiation: age 10 years or at onset of puberty, if puberty occurs at a younger age • Frequency: every 3 years *Persons aged <18 years

  11. Testing for Type 1 Diabetes: • Inform the relatives of patients with type 1 diabetes of the opportunity to be tested for type 1 diabetes risk (measuring islet autoantibodies), but only in the setting of a clinical research study. E

  12. Gestational Diabetes Test for undiagnosed type 2 diabetes at the first prenatal visit in those with risk factors, using standard diagnostic criteria. B

  13. Screening for and diagnosis of Gestational DM (GDM), if not previously known to have diabetes • One-step strategy:

  14. Screening for and diagnosis of Gestational DM (GDM), cont… • Two-step strategy:

  15. Maturity-onset diabetes of the young (MODY) • It is inherited in an autosomal dominant pattern. • Impaired insulin secretion with minimal or no defects in insulin action. • Onset of hyperglycemia at an early age (generally before age 25 years). • The diagnosis of monogenic diabetes should be considered in children with the following findings: • Strong family history of diabetes but without typical features of type 2 diabetes (nonobese, low-risk ethnic group) • Mild fasting hyperglycemia (100–150 mg/dL [5.5–8.5mmol/L]), especially if young and nonobese • Diabetes with negative autoantibodies and without signs of obesity or insulin resistance

  16. Latent autoimmune diabetes in adults (LADA) • A slowly progressive form of autoimmune or type 1 diabetes that can be treated initially without insulin injections. • The diagnosis of LADA is currently based on three criteria: • Adult age at onset of diabetes. • The presence of circulating islet autoantibodies. (Distinguishes LADA from type 2 diabetes) • Lack of a requirement for insulin for at least 6 months after diagnosis. (Distinguishes LADA from classic type 1 diabetes) Fourlano S. Diabetologia (2005) 48: 2206–2212

  17. Thanks for your patience!

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