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Diagnosis And Classification Of Diabetes Mellitus American Diabetes Association Pdf

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Report of the Committee on the classification and diagnostic criteria of diabetes mellitus

This recommendation aims to provide up-to-date information and the latest consensus on diabetes diagnosis from a group of experts in Germany. The disease diabetes mellitus is classified and its different types are described briefly. Options for diagnosis are presented including current cut-off values as well as reference intervals to recognize glucose utilization disorders like impaired fasting glucose or impaired glucose tolerance.

Special attention is paid to the measurement value imprecision. The minimal difference MD is introduced as an excellent measure to distinguish measurement results which are analytically different from each other. Potential caveats considering pre-analytics in glucose measurement and limitations of HbA 1c assessment for diagnosis of diabetes mellitus are presented.

Taken together, this recommendation provides a comprehensive overview of the state of the art in diabetes mellitus diagnosis and also critically evaluates potential pitfalls. The aim of recommendations like this one issued by the German Diabetes Association is to provide the diabetologist and his team the information he needs for his daily practice.

These recommendations are updated annually. They are written by a group of experts, but they are not evidence-based guidelines. This specific recommendation for diabetes diagnosis briefly describes the diabetes types and the different options for diagnosis.

Also the caveats and the practical procedure are presented. Diabetes is one of the major health burdens throughout the world and belongs to the four priority noncommunicable diseases. Globally, it is estimated that million adults were living with diabetes in which is almost four times as many as in , and the global prevalence nearly doubled since then. According to the results of the current study by the Robert Koch Institute, diabetes was diagnosed in 7.

Diabetes mellitus that is unrecognized or untreated over longer time periods or is insufficiently treated is associated with increased risk of cardiovascular disease, kidney dysfunction, blindness and foot amputation.

As reported by the Emerging Risk Factors Collaboration who analyzed , deaths among , people in 97 prospective studies, the life expectancy is drastically affected, i. In women, the reduction is 6. In addition, in the elderly, hypoglycemia has been recognized as another emerging complication pointing to the importance of accurately and tightly controlled blood glucose levels in these patients. Diabetes mellitus is a general term for a group of metabolic disorders with the main feature of chronic hyperglycemia.

It results from either impaired insulin secretion or impaired insulin efficacy or, most often, both. A glucose utilization disorder which occurs and is diagnosed during pregnancy for the first time. Can range from a predominant insulin resistance with relative insulin deficiency to an extensive secretory defect with insulin resistance.

Diseases involving a pancreatic exocrine deficiency e. Drug or chemically induced e. MODY types. The recommended diagnostic procedure is shown in Figure 1 and the differential diagnostic approach criteria are shown in Table 1. Differential diagnostic criteria for patients with type 1 or type 2 diabetes for diagnosing diabetes. Table modified from the National Medical Guideline for type 2 diabetes; www.

A rapid failure of oral antidiabetics can be expected with LADA. Upon suspicion of LADA: test for glutamic acid decarboxylase-antibodies is recommended. Only quality-assured laboratory methods may be used when measuring venous plasma glucose and HbA 1c in diabetes diagnostics.

If POCT systems are approved for diagnostic purposes by the manufacturer, the successful participation in EQA schemes, however, is mandatory before they can be used in diagnostics. Currently, the gold standard for diabetes diagnosis is the measurement of glucose in venous plasma. When using the fasting glucose value, a fasting time of 8—12 h is essential. The guidelines for performing an oGTT must be followed Table 2.

The sensitivity of the laboratory tests for diagnosing diabetes is specified below in ascending order in relation to the oGTT, i. For measurement results of these measurands, the question is whether the deviation from the diagnostic criterion or cut-off value exceeds this value to such an extent [i. If this is the case, one individual measurement is sufficient to confirm diabetes diagnosis.

For two values diverging the cut-off value above and below , the American Diabetes Association ADA recommends taking the higher value. This value should be repeated and becomes the deciding factor for the diagnosis. If clinically necessary, verification should be performed in time, e. How well this is realized for plasma glucose is not simply verifiable. If the diabetes diagnosis is based on an HbA 1c measurement, the confirmation measurement with the same measurand is not advisable.

Due to analytical differences between laboratories the HbA 1c measurement is currently not very well reproducible. A questionable diabetes diagnosis should therefore be confirmed using the other measurand i. A measurement result which is used as a basis for diagnosis should be confirmed so that the diagnosis is made on the basis of confirmed values.

It can be confirmed either by analysing a new blood sample using the same measurand e. If, during a second determination of the same laboratory test, there is a discrepancy in the value with regard to the cut-off value, one of the alternatives should be used for determination.

If there are disparities in the results with regard to the diagnostic criterion in two different measurands, the higher value should be confirmed. If the values are close to the limit values, they should be monitored within 3—6 months again. Proper pre-analytic handling of the blood sample is crucial. Suitable blood collection tubes must be used to completely inhibit glycolysis in the collected blood. The addition of citrate and fluoride is necessary as fluoride alone is insufficient.

The glycolytic inhibitor tubes for blood collection currently available on the German market exhibit different handling problems Table 3. One alternative recommendation for tubes without glycolytic inhibitors is to centrifuge the sample as soon as possible after blood collection.

If a period of 30 min to centrifugation is exceeded, samples should be discarded due to the occurence of glycolysis. After centrifugation, the resulting plasma supernatant must be separated from the blood cells.

This occurs during centrifugation using a gel gel tubes or mechanical separators. It is also possible to pipette off the plasma supernatant immediately after centrifugation.

Diligent and optimal pre-analytical handling of the blood collection tubes can result in a higher rate of diabetes diagnosis in practice and should not be considered over-diagnosing; however, the cut-off values used below may require adjustment and should be verified with corresponding studies. Blood collection tubes commercially available in Germany which completely inhibit glycolysis with the addition of fluoride and citrate current status The tubes must be gently inverted 10 times to adequately dissolve the additive and mix the sample with the glycolytic inhibitors.

The laboratory has to identify such types of tubes to, on the one hand, identify tubes that do not meet the filling requirements specified by the manufacturer and exclude them from the analysis, and, on the other hand, take the dilution factor of 1. This was made possible by improvements in measurement accuracy resulting from international standardization of HbA 1c measurement methods.

For patients with HbA 1c values in the range of 5. The HbA 1c value is not suitable for diagnosing diabetes if values can be expected to be influenced or falsified Table 4 ; see Practical Recommendation Glucose Monitoring and Control Testing for details on methodology.

It is also important to note that regardless of successful standardization, measurement accuracy of HbA 1c can vary considerably depending on the measurement method.

In our opinion, this problem significantly limits the exclusive use of HbA 1c for the diagnosis of diabetes; for more details, see the practical recommendations next to Table 4 in the legend to Figure 1.

In particular, the increase of HbA 1c that is associated with increasing age independent of diabetes, which can be up to an absolute value of 0. Contributing factors leading to an influence labeled with a or falsification labeled with b of the HbA 1c value.

Conditions with increased or lower life expectancy of erythrocytes hemolytic anemia, iron deficiency anemia, new blood cell formation as part of anemia treatment, status after splenectomy or illnesses of the spleen, liver or kidney a.

Uremia carbamylated Hb , high dosed long-term therapy with acetylsalicylic acid acetylated Hb b. Inhibition of glycolysis e. The clinical relevance of this phenomenon has not been investigated adequately b. Ethnicity and age HbA 1c increases with age, therefore a potential age adjustment of the diagnostic criterion must be discussed and evaluated. Moreover, discussion should be extended to the possible alternative measurands such as fructosamine or glycated albumin a.

Internal quality control must be performed every working day with suitable control material. Successful participation in EQA is required once per quarter. In order to meet the clinical requirements, the analytical variability of the absolute values at decision limits should be specified.

The MD gives specific concentrations as absolute values to specify if a measurement result differs from a cut-off value with diagnostic relevance. The MD should not be larger than A statement on the subject of MD can be found on the DDG homepage and will be published separately soon.

If the measured values lie in the overlapping areas of the inverted triangles, the diagnostic limit values cannot be differentiated from each other and the measured values cannot be used for diagnosis. In the case of elevated risk scores detected by this questionnaire, documented cardiovascular disease, presence of excess weight with additional risk factors such as hypertension, dyslipidemia increased triglyceride values or low HDL cholesterol value or a positive family history of type 2 diabetes in first-degree relatives, gestational diabetes or polycystic ovarian PCO syndrome or non-alcoholic fatty liver disease proceed as described in Figure 1.

They differ only slightly from the previously used decision limits. However, now already one value exceeding the decision limit suffices to confirm the diagnosis while previously two elevated values were required. Diabetes is confirmed if one criterion is met. For the pre-analytics of glucose determination, reference is made to the guideline for gestational diabetes; a sufficient inhibition of glycolysis is necessary. The present recommendation summarizes the current knowledge and state of the art for the diagnosis of diabetes mellitus.

With emphasis on well-described but often neglected pitfalls like measurement imprecision, pre-analytical considerations of glucose measurement and limitations of HbA 1c assessment, this work is intended to improve patient care and to draw attention of physicians to potential drawbacks in diabetes diagnosis. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

Competing interests: The funding organization s played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication. This article is an extended translation of the German-language recommendation published in Diabetologie ;12 Suppl 2 :S94— This article is published with kind permission by Thieme. It reports on the latest developments in laboratory medicine. Particular focus is placed on the diagnostic aspects of the clinical laboratory, although technical, regulatory, and educational topics are equally covered.

The Journal specializes in the publication of high-standard, competent and timely review articles on clinical, methodological and pathogenic aspects of modern laboratory diagnostics. JLM publishes only English-language articles.

Diagnosis and Classification of Diabetes Mellitus

Diabetes mellitus DM , commonly known as diabetes , is a group of metabolic disorders characterized by a high blood sugar level over a prolonged period of time. Diabetes is due to either the pancreas not producing enough insulin , or the cells of the body not responding properly to the insulin produced. Type 1 diabetes must be managed with insulin injections. The classic symptoms of untreated diabetes are unintended weight loss , polyuria increased urination , polydipsia increased thirst , and polyphagia increased hunger. Several other signs and symptoms can mark the onset of diabetes although they are not specific to the disease. In addition to the known ones above, they include blurred vision , headache , fatigue , slow healing of cuts , and itchy skin. Prolonged high blood glucose can cause glucose absorption in the lens of the eye , which leads to changes in its shape, resulting in vision changes.

Either your web browser doesn't support Javascript or it is currently turned off. In the latter case, please turn on Javascript support in your web browser and reload this page. Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. The chronic hyperglycemia of diabetes is associated with long-term damage, dysfunction, and failure of various organs, especially the eyes, kidneys, nerves, heart, and blood vessels. Several pathogenic processes are involved in the development of diabetes.

Patient education and self management are central to treating type 2 diabetes mellitus and preventing its associated complications. There are 4. Around one in three of these people will already have microvascular complications on diagnosis of type 2 diabetes mellitus T2DM [1] and the risk of developing cardiovascular complications e. Another complication, diabetic retinopathy, is a leading cause of preventable sight loss among working-age people wth T2DM in the UK [5]. More than a third of people who require kidney dialysis or a kidney transplant have diabetes [6]. Diabetes mellitus is a long-term condition characterised by hyperglycaemia as a result of insulin deficiency, insulin resistance, or both [8].

Diagnosis and management of type 2 diabetes mellitus

Background: Low and medium income countries LMICs especially in sub-Saharan Africa face unique challenges in screening and diagnosing hyperglycaemia in pregnancy. The implications of applying the WHO modifications for assessing hyperglycaemia in pregnancy in low resource settings are not known. We evaluated the significance of these recent changes in classification of hyperglycaemia among pregnant Nigerian women. Results: The results show that Overall,

The right classification for diabetes mellitus DM allows a more adequate treatment and comprises four categories: type 1 DM, type 2 DM, other types, and gestational diabetes. In some cases, there might be a superposition of situations, especially with regard to the DM that initiates in the young adult or is initially presented with diabetic ketoacidosis intermediately to type 1 and 2 DM. Thus, additions to the classic classification system have been proposed as assessing the presence of autoimmunity antibody and b cell function C-peptide to precisely define the subtypes.

Diabetes Mellitus: Screening and Diagnosis

Skip to search form Skip to main content You are currently offline. Some features of the site may not work correctly. DOI: Part 1: diagnosis and classification of diabetes mellitus. Alberti and P. Alberti , P. Zimmet Published Medicine Diabetic Medicine.

Diabetes mellitus is a group of diseases associated with various metabolic disorders, the main feature of which is chronic hyperglycemia due to insufficient insulin action. Its pathogenesis involves both genetic and environmental factors. The long-term persistence of metabolic disorders can cause susceptibility to specific complications and also foster arteriosclerosis. Diabetes mellitus is associated with a broad range of clinical presentations, from being asymptomatic to ketoacidosis or coma, depending on the degree of metabolic disorder. The classification of glucose metabolism disorders is principally derived from etiology, and includes staging of pathophysiology based on the degree of deficiency of insulin action.

Given the numbers for diabetes mellitus DM in general and diabetes mellitus type 2 DM2 in particular the more frequently occurring form , diabetes is a health and socioeconomic problem of the first magnitude. In the case of DM2, the numbers speak for themselves. It must be said that the most optimistic view is that these numbers will increase exponentially during this century will not only affect the western world, but in the year will reach million individuals worldwide. The treatment of DM2 and its complications costs Canada 7 to 20 billion dollars annually. In the European Union, the direct annual medical cost of patients with DM2 is 29 million euros; of this amount, only 3. All this data, and the direct consequences of the illness for the patients, makes DM, without any doubt, one of the principal current social health problems. Diagnosis of diabetes mellitus and other types of changes in glucose tolerance.

Classifying Diabetes

This is a corrected version of the article that appeared in print. Related U. Diabetes mellitus is one of the most common diagnoses made by family physicians. Uncontrolled diabetes can lead to blindness, limb amputation, kidney failure, and vascular and heart disease. Screening patients before signs and symptoms develop leads to earlier diagnosis and treatment, but may not reduce rates of end-organ damage. Randomized trials show that screening for type 2 diabetes does not reduce mortality after 10 years, although some data suggest mortality benefits after 23 to 30 years.

The major revision was that HbA1c became the first line, that a diagnosis of diabetes was enabled using HbA1c and the plasma glucose level at one time. Early diagnosis and treatment of diabetes are expected by this revision. They also adopted HbA1c in diagnostic criteria to reflect chronic hyperglycemic states better. Revision of the diagnosis is the difficult problem because it is not the simple thing to replace it by something else. It needs the continuity with the previous diagnostic criteria, the scientific validity based on evidence, the consistency with overseas diagnostic criteria, and the clinical feasibility.

Diabetes is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. The chronic hyperglycemia of diabetes is associated with long-term damage, dysfunction, and failure of differentorgans, especially the eyes, kidneys, nerves, heart, and blood vessels. Several pathogenic processes are involved in the development of diabetes. The basis of the abnormalities in carbohydrate, fat, and protein metabolism in diabetes is deficient action of insulin on target tissues. Impairment of insulin secretion and defects in insulin action frequently coexist in the same patient, and it is often unclear which abnormality, if either alone, is the primary cause of the hyperglycemia. Symptoms of marked hyperglycemia include polyuria, polydipsia, weight loss, sometimes with polyphagia, and blurred vision. Impairment of growth and susceptibility to certain infections may also accompany chronic hyperglycemia.

Diagnosis and Classification of Diabetes Mellitus

This recommendation aims to provide up-to-date information and the latest consensus on diabetes diagnosis from a group of experts in Germany. The disease diabetes mellitus is classified and its different types are described briefly. Options for diagnosis are presented including current cut-off values as well as reference intervals to recognize glucose utilization disorders like impaired fasting glucose or impaired glucose tolerance. Special attention is paid to the measurement value imprecision. The minimal difference MD is introduced as an excellent measure to distinguish measurement results which are analytically different from each other.

Diagnosis and classification of diabetes mellitus.

This assay is not useful in determining day-to-day glucose control and should not be used to replace daily home testing of blood glucose. Diabetes mellitus is a chronic disorder associated with disturbances in carbohydrate, fat, and protein metabolism characterized by hyperglycemia. It is one of the most prevalent diseases, affecting approximately 24 million individuals in the United States. Long-term treatment of the disease emphasizes control of blood glucose levels to prevent the acute complications of ketosis and hyperglycemia.

Diabetes Mellitus: Screening and Diagnosis

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Alicia H. 19.05.2021 at 05:32

American Diabetes Association Article; Figures & Tables; Info & Metrics; PDF Classification of Diabetes Mellitus and Other Categories of Glucose Regulation.

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