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PARITA PATEL, MD, and ALLISON MACEROLLO, MD, Department of Family Medicine, The Ohio State University, Columbus, Ohio

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Β  Related Editorial

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Based on etiology, diabetes is classified as type 1 diabetes mellitus, type 2 diabetes mellitus, latent autoimmune diabetes, maturity-onset diabetes of youth, and miscellaneous causes. The diagnosis is based on measurement of A1C level, fasting or random blood glucose level, or oral glucose tolerance testing. Although there are conflicting guidelines, most agree that patients with hypertension or hyperlipidemia should be screened for diabetes. Diabetes risk calculators have a high negative predictive value and help define patients who are unlikely to have diabetes. Tests that may help establish the type of diabetes or the continued need for insulin include those reflective of beta cell function, such as C peptide levels, and markers of immune-mediated beta cell destruction (e.g., autoantibodies to islet cells, insulin, glutamic acid decarboxylase, tyrosine phosphatase [IA-2α and IA-2β]). Antibody testing is limited by availability, cost, and predictive value.

Prevention, timely diagnosis, and treatment are important in patients with diabetes mellitus. Many of the complications associated with diabetes, such as nephropathy, retinopathy, neuropathy, cardiovascular disease, stroke, and death, can be delayed or prevented with appropriate treatment of elevated blood pressure, lipids, and blood glucose.14

In 1997, the American Diabetes Association (ADA) introduced an etiologically based classification system and diagnostic criteria for diabetes,5 which were updated in 2010.1 Type 2 diabetes accounts for approximately 90 to 95 percent of all persons with diabetes in the United States, and its prevalence is increasing in adults worldwide.6 With the rise in childhood obesity, type 2 diabetes is increasingly being diagnosed in children and adolescents.6

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reverses diabetes type 2 mellitus 10 code (⭐️ keto) | reverses diabetes type 2 gouthow to reverses diabetes type 2 for SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical for 1 last update 31 May 2020 recommendationClinical recommendationEvidence ratingReferences

Patients with a sustained blood pressure of greater than 135/80 mm Hg should be screened for diabetes.

A

34, 42

Patients with hypertension or hyperlipidemia should be screened for diabetes.

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33

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C

13

A1C value of greater than 6.5 percent on two separate occasions is the 1 last update 31 May 2020 diagnostic for diabetes.A1C value of greater than 6.5 percent on two separate occasions is diagnostic for diabetes.

C

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Patients at increased risk of diabetes should be counseled on effective strategies to lower their risk, such as weight loss and exercise.

C

9, 10


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.xml.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

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Patients with a sustained blood pressure of greater than 135/80 mm Hg should be screened for diabetes.

A

34, 42

Patients with hypertension or hyperlipidemia should be screened for diabetes.

B

33

Risk calculators can be used to determine which patients do not need screening for diabetes.

C

13

A1C value of greater than 6.5 percent on two separate occasions is diagnostic for diabetes.

C

18

Patients at increased risk of diabetes should be counseled on effective strategies to lower their risk, such as weight loss and exercise.

C

9reverses diabetes type 2 danger zone (πŸ”₯ reversal) | reverses diabetes type 2 home remedies forhow to reverses diabetes type 2 for , 10


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.xml.

The risk of diabetes is increased in close relatives suggesting a genetic predisposition, although no direct genetic link has been identified.7 Type 1 diabetes accounts for 5 to 10 percent of persons with diabetes6 and is characterized by insulin deficiency that is typically an autoimmune-mediated condition.

Latent autoimmune diabetes in adults includes a heterogenous group of conditions that are phenotypically similar to type 2 diabetes, but patients have autoantibodies that are common with type 1 diabetes. Diagnostic criteria include age of 30 years or older; no insulin treatment for six months after diagnosis; and presence of autoantibodies to glutamic acid decarboxylase, islet cells, tyrosine phosphatase (IA-2α and IA-2β), or insulin.

Patients with maturity-onset diabetes of youth typically present before 25 years of age, have only impaired insulin secretion, and have a monogenetic defect that leads to an autosomal dominant inheritance pattern. These patients are placed in a subcategory of having genetic defects of beta cell.8

The old terminology of prediabetes has now been replaced with “categories of increased risk for diabetes.” This includes persons with impaired fasting glucose, impaired glucose tolerance, or an A1C level of 5.7 to 6.4 percent.1,9reverses diabetes type 2 keto (πŸ‘ nursing diagnosis) | reverses diabetes type 2 good foods to eathow to reverses diabetes type 2 for ,10

Diagnostic Criteria and Testing

The 1997 ADA consensus guidelines lowered the blood glucose thresholds for the diagnosis of diabetes.5 This increased the number of patients diagnosed at an earlier stage, although no studies have demonstrated a reduction in long-term complications. Data suggest that as many as 5.7 million persons in the United States have undiagnosed diabetes.6Β  Table 1 compares specific diagnostic tests for diabetes.1114

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Table for 1 last update 31 May 2020 1.Table 1.

Comparison of Diagnostic Tests for Diabetes

Testreverses diabetes type 2 young age (⭐️ epidemiology) | reverses diabetes type 2 diethow to reverses diabetes type 2 for Sensitivity (%)Specificity (%)reverses diabetes type 2 fatigue (πŸ‘ yeast infection) | reverses diabetes type 2 blood sugarhow to reverses diabetes type 2 for PPV*NPV*Medicare reimbursement

OGTT (two hour)

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$19

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≥ 140 mg per dL (7.8 mmol per L)

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92

30.5

97

$6

≥ 150 mg per dL (8.3 mmol per L)

for 1 last update 31 May 2020 5050

95

39.9

the 1 last update 31 May 2020 96.796.7

≥ 160 mg per dL (8.9 mmol per L)

44

96

41.2

for 1 last update 31 May 2020 96.496.4

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for 1 last update 31 May 2020

≥ 170 mg per dL (9.4 mmol per L)

42

97

47.2

96.3

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≥ 180 mg per dL (10.0 mmol per L)

39

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55.5

96

A1C levels (%)12Β§

for 1 last update 31 May 2020 6.16.1

63.2

97.4

60.8

97.6

$14, serum test or point of-care test

6.5

for 1 last update 31 May 2020 42.842.8

99.6

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96.5

7.0

28.3

99.9

94.7

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Diabetes Risk Calculator13,14

78.2 to 88.2

66.8 to 74.9

6.3 to 13.6

99.2 to 99.3

the 1 last update 31 May 2020 FreeFree


NPV = negative predictive value; OGTT = oral glucose tolerance test; PPV = positive predictive value.

*—Calculated based on prevalence of 6 percent.

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‡—reverses diabetes type 2 characteristics (⭐️ carb count) | reverses diabetes type 2 autoimmunehow to reverses diabetes type 2 for Reference standard was OGTT.

Β§—Reference standard was fasting blood glucose measurement.

Information from references 11 through 14.

Table 1.

Comparison of Diagnostic Tests for Diabetes

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OGTT (two hour)

Reference standard

$19

Random blood glucose level11

≥ 140 mg per dL (7.8 mmol per L)

55

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30.5

97

$6

≥ 150 mg per dL (8.3 mmol per L)

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95

39.9

96.7

for 1 last update 31 May 2020

≥ 160 mg per dL (8.9 mmol per L)

44

96

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96.4

≥ 170 mg per dL (9.4 mmol per L)

42

97

47.2

for 1 last update 31 May 2020 96.396.3

≥ 180 mg per dL (10.0 mmol per L)

39

98

55.5

96

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A1C levels (%)12Β§

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the 1 last update 31 May 2020 6.16.1

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97.4

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$14, serum test or point of-care test

6.5

42.8

99.6

87.2

96.5

7.0

28.3

99.9

94.7

the 1 last update 31 May 2020 95.695.6

Diabetes Risk Calculator13,14Diabetes Risk Calculator13,14

78.2 to the 1 last update 31 May 2020 88.278.2 to 88.2

66.8 to 74.9

6.3 to 13.6

99.2 to the 1 last update 31 May 2020 99.399.2 to 99.3

for 1 last update 31 May 2020 FreeFree


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*—Calculated based on prevalence of 6 percent.

†—Based on 2009 for 1 last update 31 May 2020 rates.†—Based on 2009 rates.

‡—Reference standard was OGTT.

Β§—Reference standard for 1 last update 31 May 2020 was fasting blood glucose measurement.Β§—Reference standard was fasting blood glucose measurement.

Information from references 11 through 14.

TESTS TO DIAGNOSE DIABETES

Blood Glucose Measurements. The diagnosis of diabetes is based on one of three methods of blood glucose measurement (Table 2).1 Diabetes can be diagnosed if the patient has a fasting blood glucose level of 126 mg per dL (7.0 mmol per L) or greater on two separate occasions. The limitations of this test include the need for an eight-hour fast before the blood draw, a 12 to 15 percent day-to-day variance in fasting blood glucose values, and a slightly lower sensitivity for predicting microvascular complications.15,16

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Table 2.

Diagnostic Criteria for Diabetes Mellitus

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Categories of increased risk (formerly prediabetes)

Fasting glucose test: 100 to 125 mg per dL (5.6 to 6.9 mmol per L)

Two-hour OGTT (75-g load): 140 to 199 mg per dL (7.8 to 11.0 mmol per L)

A1C measurement: 5.7 to 6.4 percent

Type 1, type 2, LADA, MODY

Fasting glucose test: ≥ 126 mg per dL (7.0 mmol per L)

Type 1 diabetes: decreased C peptide, presence of GADA and ICA

LADA: increased C peptide, presence of GADA and ICA, tyrosine phosphatase antibody (IA-2), anti-insulin antibody

MODY: genetic testing

Two-hour OGTT (75-g load): ≥ 200 mg per dL (11.1 mmol per L)

Random glucose test: ≥ 200 mg per dL with symptoms

A1C measurement: ≥ 6.5 percent

Gestational the 1 last update 31 May 2020 diabetesGestational diabetes

OGTT (100-g load):

Fasting, 95 mg per dL (5.3 mmol per L)

One hour, 180 mg per dL (10.0 mmol per L)

Two hour, 155 mg per dL (8.6 mmol per L)

Three hour, 140 mg per dL

Need at least two abnormal results

One-hour Glucola OGTT (50-g load):

140 mg per dL (7.8 mmol per L), confirm diagnosis with 75- or 100-g OGTT

OGTT (75-g load):

Fasting, 95 mg per dL

One for 1 last update 31 May 2020 hour, 180 mg per dLOne hour, 180 mg per dL

Two hour, 155 mg per dL


GADA = antiglutamic acid decarboxylase antibody; ICA = anti-islet cell antibody; LADA = latent autoimmune diabetes in adults; MODY = maturity-onset diabetes of youth; OGTT = oral glucose tolerance test.

Information from reference 1.

Table 2.

Diagnostic Criteria for Diabetes Mellitus

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Categories of increased risk (formerly prediabetes)

Fasting for 1 last update 31 May 2020 glucose test: 100 to 125 mg per dL (5.6 to 6.9 mmol per L)Fasting glucose test: 100 to 125 mg per dL (5.6 to 6.9 mmol per L)

Two-hour OGTT (75-g load): 140 to 199 mg per dL (7.8 the 1 last update 31 May 2020 to 11.0 mmol per L)Two-hour OGTT (75-g load): 140 to 199 mg per dL (7.8 to 11.0 mmol per L)

A1C measurement: 5.7 to 6.4 percent

Type 1, type 2, LADA, MODY

Fasting glucose test: ≥ 126 mg per dL (7.0 mmol per L)

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Type 1 diabetes: decreased C peptide, presence of GADA and ICA

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MODY: genetic testing

Two-hour OGTT (75-g load): ≥ 200 mg per dL (11.1 mmol per L)

Random glucose test: ≥ 200 mg per dL with symptoms

A1C measurement: ≥ 6.5 percent

Gestational diabetes

OGTT (100-g load):

Fasting, 95 mg per dL (5.3 mmol per L)

One hour, 180 mg per for 1 last update 31 May 2020 dL (10.0 mmol per L)One hour, 180 mg per dL (10.0 mmol per L)

Two hour, 155 mg per dL (8.6 mmol per for 1 last update 31 May 2020 L)Two hour, 155 mg per dL (8.6 mmol per L)

Three hour, 140 mg per dL

Need at least two abnormal results

One-hour Glucola OGTT (50-g load):

140 mg per dL (7.8 mmol per L), confirm diagnosis with 75- or 100-g OGTT

OGTT (75-g load):

Fasting, 95 mg per dL

One hour, 180 mg per dL

Two for 1 last update 31 May 2020 hour, 155 mg per dLTwo hour, 155 mg per dL


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Information from reference 1.Information from reference 1.

Diabetes can also be diagnosed with a random blood glucose level of 200 mg per dL (11.1 mmol per L) or greater if classic symptoms of diabetes (e.g., polyuria, polydipsia, weight loss, blurred vision, fatigue) are present. Lower random blood glucose values (140 to 180 mg per dL [7.8 to 10.0 mmol per L]) have a fairly high specificity of 92 to 98 percent; therefore, patients with these values should undergo more definitive testing. A low sensitivity of 39 to 55 percent limits the use of random blood glucose testing.15

The oral glucose tolerance test is considered a first-line diagnostic test. Limitations include poor reproducibility and patient compliance because an eight-hour fast is needed before the 75-g glucose load, which is followed two hours later by a blood draw.17 The criterion for diabetes is a serum blood glucose level of greater than 199 mg per dL (11.0 mmol per L).

reverses diabetes type 2 insulin pump (πŸ‘ new zealand) | reverses diabetes type 2 quoteshow to reverses diabetes type 2 for In 2003, the ADA lowered the threshold for diagnosis of impaired fasting glucose to include a fasting glucose level between 100 and 125 mg per dL (5.6 and 6.9 mmol per L). Impaired glucose tolerance continues to be defined as a blood glucose level between 140 and 199 mg per dL (7.8 and 11.0 mmol per L) two hours after a 75-g load. Patients meeting either of these criteria are at significantly higher risk of progression to diabetes and should be counseled on effective strategies to lower their risk, such as weight loss and exercise.1,9

A1C. A1C measurement has recently been endorsed by the ADA as a diagnostic and screening tool for diabetes.1 One advantage of using A1C measurement is the ease of testing because it does not require fasting. An A1C level of greater than 6.5 percent on two separate occasions is considered diagnostic of diabetes.18 Lack of standardization has historically deterred its use, but this test is now widely standardized in the United States.19 A1C measurements for diagnosis of diabetes should be performed by a clinical laboratory because of the lack of standardization of point-of-care testing. Limitations of A1C testing include low sensitivity, possible racial disparities, and interference by anemia and some medications.15

TESTS TO IDENTIFY TYPE OF DIABETES

Tests that can be used to establish the etiology of diabetes include those reflective of beta cell function (e.g., C peptide) and markers of immune-mediated beta cell destruction (e.g., insulin, islet cell, glutamic acid decarboxylase, IA-2α and IA-2β autoantibodies). reverses diabetes type 2 odor (πŸ‘ urine test) | reverses diabetes type 2 treatment nhshow to reverses diabetes type 2 for Table 3 presents the characteristics of these tests.20 the 1 last update 31 May 2020 ––27

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Table 3.

Characteristics of Special Tests for the Diagnosis of Diabetes Mellitus

TestTestType of diabetes
Type 1Type 2LADAMedicare reimbursement*Medicare reimbursement*

C peptide

< 1.51 ng per mL (0.5 nmol per L): PPV of 96 percent for diagnosis in adults and children20

> 1.51 ng per mL: NPV of 96 percent for diagnosis in adults and children20

Not available

$30

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reverses diabetes type 2 coronavirus risk (πŸ”΄ origin) | reverses diabetes type 2 bornhow to reverses diabetes type 2 for 60 percent prevalence in adults and children21

7 to 34 percent prevalence in adults and children23,24

Presence: PPV of 92 percent for requiring insulin at three years in persons 15 to 34 years of age26

the 1 last update 31 May 2020 $28$28

73 percent prevalence in for 1 last update 31 May 2020 children2273 percent prevalence in children22

NPV of 94 percent for requiring insulin at six years in adults25

Absence: NPV of 49 percent for requiring insulin at three years in persons 15 to 34 years of age26

IA-2α and IA-2β †

40 percent prevalence in adults and children21

2.2 percent prevalence in adults25

PPV of 75 percent for requiring insulin at three years in persons 15 to 34 years of age26

Cost not available

86 percent prevalence in children27

ICA

75 to 85 percent prevalence in adults and children21

4 to 21 percent prevalence in adults24

PPV of 86 percent for requiring insulin at three years in persons 15 to 34 years of age26

$28

84 percent prevalence in children22


GADA = anti-glutamic acid decarboxylase antibody; ICA = anti-islet cell antibody; LADA = latent autoimmune diabetes in adults; NPV = negative predictive value; PPV = positive predictive value.

*—Based on for 1 last update 31 May 2020 2009 rates.*—Based on 2009 rates.

†—Tyrosine phosphatase antibodies.

Information from the 1 last update 31 May 2020 references 20 through 27.Information from references 20 through 27.

Table 3.

Characteristics of Special Tests for the Diagnosis of Diabetes Mellitus

TestType of for 1 last update 31 May 2020 diabetesType of diabetes
Type the 1 last update 31 May 2020 1Type 1Type 2LADAMedicare reimbursement*

C peptide

< 1.51 ng per mL (0.5 nmol per L): PPV of 96 percent for diagnosis in adults and children20

> 1.51 ng per mL: NPV of 96 percent for diagnosis in adults and children20

Not for 1 last update 31 May 2020 availableNot available

$30

GADA

60 percent prevalence in adults and children21

7 to 34 percent prevalence in adults and children23,24

Presence: PPV of 92 percent for requiring insulin at three years in persons 15 to 34 years of age26

$28

73 percent prevalence in children22

NPV of 94 percent for requiring insulin at six years in adults25

Absence: NPV of 49 percent for requiring insulin at three years in persons 15 to 34 years of age26

IA-2α and IA-2β †

40 percent prevalence in adults and children21

2.2 percent prevalence in adults25

PPV of 75 percent for requiring insulin at three years in persons 15 to 34 years of age26

Cost not available

86 percent prevalence in children27

ICA

75 to 85 percent prevalence in adults and for 1 last update 31 May 2020 children21 75 to 85 percent prevalence in adults and children21

4 to 21 percent prevalence in adults24

PPV of 86 percent for requiring insulin at three years in persons 15 to 34 years of age26

$28

84 percent prevalence in children22


GADA = anti-glutamic acid decarboxylase antibody; ICA = anti-islet cell antibody; LADA = latent autoimmune diabetes in adults; NPV = negative predictive value; PPV = positive predictive value.

*—Based on 2009 rates.

†—reverses diabetes type 2 statistics uk (πŸ‘ vegetarian diet) | reverses diabetes type 2 treathow to reverses diabetes type 2 for Tyrosine phosphatase antibodies.

Information from references 20 through 27.

C peptide is linked to insulin to form proinsulin and reflects the amount of endogenous insulin. Patients with type 1 diabetes have low C peptide levels because of low levels of endogenous insulin and beta cell function. Patients with type 2 diabetes typically have normal to high levels of C peptide, reflecting higher amounts of insulin but relative insensitivity to it. In a Swedish study of patients with clinically well-defined type 1 or 2 diabetes, 96 percent of patients with type 2 diabetes had random C peptide levels greater than 1.51 ng per mL (0.50 nmol per L), whereas 90 percent of patients with type 1 diabetes had values less than 1.51 ng per mL.20 In the clinically undefined population, which is the group in which the test is most often used, the predictive value is likely lower.

Antibody testing is limited by availability, cost, and predictive value, especially in black and Asian patients. Prevalence of any antibody in white patients with type 1 diabetes is 85 to 90 percent,5 whereas the prevalence in similar black or Hispanic patients is lower (19 percent in both groups in one study).28 In persons with type 2 diabetes, the prevalence of islet cell antibody is 4 to 21 percent; glutamic acid decarboxylase antibody, 7 to 34 percent; IA-2, 1 to 2 percent; and any antibody, 11.6 percent.24,25,29 In healthy persons, the prevalence of any antibody marker is 1 to 2 percent30; thus, overlap of the presence of antibodies in various types of diabetes and patients limits the utility of individual tests.

Screening

As with any condition, a rationale for screening should first be established. Diabetes is a common disease that is associated with significant morbidity and mortality. It has an asymptomatic stage that may be present for up to seven years before diagnosis. The disease is treatable, and testing is acceptable and accessible to patients. Early treatment of diabetes that was identified primarily by symptoms improves microvascular outcomes.31Β  However, it is not clear whether universal screening reduces diabetes-associated morbidity and mortality. Table 4Table 4 presents screening guidelines from several organizations.1,8,3238

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Table 4.

Practice Guidelines for Diabetes Mellitus Screenings

OrganizationRecommendations

the 1 last update 31 May 2020 DiabetesDiabetes

AACE32

reverses diabetes type 2 statistics uk (πŸ‘ treatments and regiments) | reverses diabetes type 2 test kithow to reverses diabetes type 2 for All persons 30 years or older who are at risk of having or developing type 2 diabetes should be screened annually.

ADA8*

Testing to detect type 2 diabetes should be considered in asymptomatic adults with a BMI of 25 kg per m2 or greater and one or more additional risk factors for diabetes.

Additional risk factors include physical inactivity; hypertension; HDL cholesterol level of less than 35 mg per dL (0.91 mmol per L) or a triglyceride level of greater than 250 mg per dL (2.82 mmol per L); history of CV disease; A1C level of 5.7 percent or greater; IGT or IFG on previous testing; first-degree relative with diabetes; member of a high-risk ethnic group; in women, history of gestational diabetes or delivery of a baby greater than 4.05 kg (9 lb), or history of PCOS; other conditions associated with insulin resistance (e.g., severe obesity, acanthosis nigricans).

In persons without risk factors, testing should begin at 45 years of age.

If test results are normal, repeat testing should be performed at least every three years.

CTFPHC33

There is fair evidence to recommend screening patients with hypertension or hyperlipidemia for type 2 diabetes to reduce the incidence of CV events and CV mortality.

USPSTF34

All adults with a sustained blood pressure of greater than 135/80 mm Hg should be screened for diabetes.

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Gestational for 1 last update 31 May 2020 diabetesGestational diabetes

AACE32

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Physicians should discuss screening with patients and make case-by-case decisions.


AACE = American Association of Clinical Endocrinologists; ACOG = American College of Obstetricians and Gynecologists; ADA = American Diabetes Association; BMI = body mass index; CTFPHC = Canadian Task Force on Preventive Health Care; CV = cardiovascular; HDL = high-density lipoprotein; IFG = impaired fasting glucose; IGT = impaired glucose tolerance; OGTT = oral glucose tolerance test; PCOS = polycystic ovary syndrome; USPSTF = U.S. Preventive Services Task Force.

*—Expert consensus process, rather than an explicitly evidence-based process, was used to develop guidelines and practice parameters.

Information from references 1, 8, and 32 through 38Information from references 1, 8, and 32 through 38.

Table the 1 last update 31 May 2020 4.Table 4.

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AACE32

All persons 30 years or older who are at risk of having or developing type 2 diabetes should be screened annually.

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Testing to detect type 2 diabetes should be considered in asymptomatic adults with a BMI of 25 kg per m2 or greater and one or more additional risk factors for diabetes.

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Additional risk factors include physical inactivity; hypertension; HDL cholesterol level of less than 35 mg per dL (0.91 mmol per L) or a triglyceride level of greater than 250 mg per dL (2.82 mmol per L); history of CV disease; A1C level of 5.7 percent or greater; IGT or IFG on previous testing; first-degree relative with diabetes; member of a high-risk ethnic group; in women, history of gestational diabetes or delivery of a baby greater than 4.05 kg (9 lb), or history of PCOS; other conditions associated with insulin resistance (e.g., severe obesity, acanthosis nigricans).

In persons without risk factors, testing should begin at 45 years of age.

If test results are normal, repeat testing should be performed at least every three years.

CTFPHC33

There is fair evidence to recommend screening patients with hypertension or hyperlipidemia for type 2 diabetes to reduce the incidence of CV events and CV mortality.

USPSTF34

All adults with a sustained blood pressure of greater than 135/80 mm Hg should be screened for diabetes.

Current evidence is insufficient to assess balance of benefits and harms of routine screening for type 2 diabetes in asymptomatic, normotensive patients.

Gestational the 1 last update 31 May 2020 diabetesGestational diabetes

AACE32

In all pregnant women, fasting glucose should be measured at the first prenatal visit (no later than 20 weeks'' gestation.

Testing may be excluded in low-risk women (see ACOG criteria above). All other women should receive Glucola test or OGTT at 24 to 28 weeks'' gestation.

Physicians should discuss screening with patients and make case-by-case decisions.


AACE = American Association of Clinical Endocrinologists; ACOG = American College of Obstetricians and Gynecologists; ADA = American Diabetes Association; BMI = body mass index; CTFPHC = Canadian Task Force on Preventive Health Care; CV = cardiovascular; HDL = high-density lipoprotein; IFG = impaired fasting glucose; IGT = impaired glucose tolerance; OGTT = oral glucose tolerance test; PCOS = polycystic ovary syndrome; USPSTF = U.S. Preventive Services Task Force.

*—Expert consensus process, rather than an explicitly evidence-based process, was used to develop guidelines and practice parameters.

Information the 1 last update 31 May 2020 from references 1, 8, and 32 through 38.Information from references 1, 8, and 32 through 38.

TYPE 1 DIABETES

Screening for type 1 diabetes is not recommended because there is no accepted treatment for patients who are diagnosed in the asymptomatic phase. The Diabetes Prevention Trial identified a group of high-risk patients based on family history and positivity to islet cell antibodies. However, treatment did not prevent progression to type 1 diabetes in these patients.39

TYPE 2 DIABETES

Medications and lifestyle interventions may reduce the risk of diabetes, although 20 to 30 percent of patients with type 2 diabetes already have complications at the time of presentation.40 Although a recent analysis suggests that screening for and treating impaired glucose tolerance in persons at risk of diabetes may be cost-effective, the data on screening for type 2 diabetes are less certain.41 It is unclear whether the early diagnosis of type 2 diabetes through screening programs, with subsequent intensive interventions, provides an incremental benefit in final health outcomes compared with initiating treatment after clinical diagnosis.

Guidelines differ regarding who should be screened for type 2 diabetes. The U.S. Preventive Services Task Force (USPSTF) recommends limiting screening to adults with a sustained blood pressure of greater than 135/80 mm Hg.34,42 The American Academy of Family Physicians concurs, but specifically includes treated and untreated patients.43 The Canadian Task Force on Preventive Health Care recommends screening all patients with hypertension or hyperlipidemia.33 The ADA recommends screening a much broader patient population based on risk.1

There are several questionnaires to predict a patient''s phenotype, history, presentation, and selective laboratory testing is the best way to manage patients with diabetes.

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The Authors

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PARITA PATEL, MD, is a clinical assistant professor of family medicine at The Ohio State University College of Medicine in Columbus. She is also program director of the university''div-gpt-ad-right''s Collections


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Home / Journals for 1 last update 31 May 2020 // afp / Vol. 81/No. 7(April 1, 2010) / Diabetes Mellitus: Diagnosis and Screening