Guidelines for Testing in Diabetes Subgroups: ADA Standards of Care 2016

Diabetes when put simply is a serious disease in which the body cannot properly control the amount of sugar in the blood because it does not have enough insulin. Diabetes itself as a disease can be categorized into various sub-classifications, with each classification warranting its own testing mechanism. Its important for every physician to know this to facilitate diagnosis in different classifcations.

American Diabetes Association issued Standards of Care in Diabetes in 2016, a section of which deals with the testing guidelines for different types of diabetes. For the same Diabetes has been categorized into the following 4 classifications:-

CLASSIFICATION-

Diabetes can be classified into the following general categories:

• 1. Type 1 diabetes (due to b-cell destruction, usually leading to absolute insulin deficiency)


• 2. Type 2 diabetes (due to a progressive loss of insulin secretion 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, e.g., monogenic diabetes syndromes (such as neonatal diabetes and maturity-onset diabetes of the young [MODY]), diseases of the exocrine pancreas (such as cystic fibrosis), and drug- or chemical-induced diabetes (such as with glucocorticoid use, in the treatment of HIV/AIDS or after organ transplantation) .

The Volume further goes on to give recommendations on how to detect the various categories of Diabetes disease in both children and adults.

Following are the category wise recommendations:

CATEGORIES OF INCREASED RISK FOR DIABETES (PREDIABETES)

Recommendations:

• 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.


• For all patients, testing should begin at age 45 years.


• If tests are normal, repeat testing carried out at a minimum of 3-year intervals is reasonable.


• To test for prediabetes, fasting plasma glucose, 2-h plasma glucose after 75-g oral glucose tolerance test, and A1C are equally appropriate.


• In patients with prediabetes, identify and, if appropriate, treat other cardiovascular disease risk factors.


• 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.

TYPE 1 DIABETES

Recommendations:

• 1.Blood glucose rather than A1C should be used to diagnose acute onset of type 1 diabetes in individuals with symptoms of hyperglycemia.


• 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.

TYPE 2 DIABETES

Recommendations:

• 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.


• 2.For all patients, testing should begin at age 45 years.


• 3.If tests are normal, repeat testing carried out at a minimum of 3-year intervals is reasonable.


• 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.


• 5.In patients with diabetes, identify and, if appropriate, treat other cardiovascular disease risk factors.


• 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.

GESTATIONAL DIABETES MELLITUS

Recommendations:

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

2.Test for gestational diabetes mellitus at 24–28 weeks of gestation in pregnant women not previously known to have diabetes. A c Screen women with gestational diabetes mellitus for persistent diabetes at 6–12 weeks postpartum,using the oral glucose tolerance test and clinically appropriate nonpregnancy diagnostic criteria.

3. Women with a history of gestational diabetes mellitus should have lifelong screening for the development of diabetes or prediabetes at least every 3 years.

4. Women with a history of gestational diabetes mellitus found to have prediabetes should receive lifestyle interventions or metformin to prevent diabetes.

MONOGENIC DIABETES SYNDROMES

Recommendations:

1.All children diagnosed with diabetes in the first 6 months of life should have genetic testing.

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.

3.Because a diagnosis of maturityonset diabetes of the young may impact therapy and lead to identi- fication 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 dominant pattern of inheritance) to a specialist for further evaluation.

CYSTIC FIBROSIS–RELATED DIABETES

Recommendations:

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.

2. A1C as a screening test for cystic fibrosis–related diabetes is not recommended.

3. Patients with cystic fibrosis–related diabetes should be treated with insulin to attain individualized glycemic goals.

4. In patients with cystic fibrosis and impaired glucose tolerance without confirmed diabetes, prandial insulin therapy should be considered to maintain weight.

5.Beginning 5 years after the diagnosis of cystic fibrosis–related diabetes, annual monitoring for complications of diabetes is recommended.

For more information click on the following link:

http://care.diabetesjournals.org/site/misc/2016-Standards-of-Care.pdf