Diabetes mellitus (DM) is a. metabolic disorder in which there is and adults with diabetes mellitus, another 54 million people suffer from a …
DIABETES SCREENING GUIDELINES
Washington State Clinical Laboratory Advisory Council to the Washington State Department of Health Originally published: March 1999 Revised: October 2000/May 2003/May 2007
FOR EDUCATIONAL PURPOSES ONLY The individual clinician is in the best position to determine which tests are most appropriate for a particular patient
GENERAL POPULATION
Who should be screened? 1 General screening is recommended at 3 year intervals only for those patient populations known to be at high risk High risk includes one or more of the following: 45 years of age, has a sibling or parent with diabetes; overweight BMI 25 kg/m2; are members of a high-risk ethnic population; have delivered a baby weighing 9 lbs or previously diagnosed with GDM,; are hypertensive 140/90 mm Hg in adults; have an HDL cholesterol level 35 mg/dL and/or a triglyceride level 250 mg/dL; polycystic ovary disease; history of vascular disease; habitual physical inactivity 2 Patient screening is recommended yearly for previous impaired glucose tolerance IGT; previous impaired fasting glucose IFG; overweight people with one or more other risk factors Screening Procedure Capillary vs Venous Blood:
Testing of blood with a blood glucose monitoring device intended for home use is not considered a diagnostic procedure A whole blood screening test must be confirmed two more times using plasma from a venous sample 1 Fasting Plasma Glucose FPG 126 mg/dL 70 mmol/L Fasting is defined as no consumption of food or beverage other than water for at least 8 hours OR 2 2-hour plasma glucose 200 mg/dL 111 mmol/L during an oral glucose tolerance test OGTT [This measure OGTT is not recommended for routine clinical use] The test requires the use of a glucose load containing the equivalent of 75-g anhydrous glucose dissolved in water OR 3 Symptoms of diabetes plus casual random plasma glucose concentration 200 mg/dL 111 mmol/L Casual random is defined as any time of day without regard to time since last meal The classic symptoms of diabetes include polyuria, polydipsia, and unexplained weight loss
In the absence of unequivocal hyperglycemia with symptoms, these criteria must be confirmed by repeat testing preferably the FPG on a subsequent day
Yes Confirmed Diabetes
Further monitoring of patient with HbA1c
No No further action
Exclude those who have no high risk indicators Non-diabetic
individuals with an FPG 100 mg/dL 56mmol/L but 126 mg/dL 70 mmol/L are considered to have impaired fasting glucose IFG, and those with 2-h values in the OGTT 140 mg/dL 78 mmol/L but 200 mg/dL 111 mmol/L are defined as having impaired glucose tolerance IGT Both IFG and IGT are risk factors for future diabetes The method of testing should be one certified by the National Glycohemoglobin Standardization Program NGSP REFERENCES: 1 American Diabetes Association Position Statement: Diagnosis and Classification of Diabetes Mellitus Diabetes Care, Volume 30 Supplement 1, January 2007: S42-47 1979 2 American Diabetes Association Professional Practice and Executive Committees: Screening for Type 2 Diabetes Diabetes Care, Volume 27 Supplement 1, January 2004: S2, S11-14 3 US Preventive Services Task Force USPSTF Annals of Internal Medicine 2003; 1383, 212-14, 215-29 4 MW Carpenter Donald R Coustan, Diagnosis of Gestational Diabetes Diabetes Care, Volume 21, Supplement 2, B5-8, 1998 5 Metzger BE, Coustan DR Eds: Proceeding of the Fourth International Work-shop-Conference on Gestatio 
nal Diabetes Mellitus Diabetes Care, Volume 21, Supplement 2, B161-7, 1998 6 Expert Committee on the
Diagnosis and Classification of Diabetes Mellitus Committee Report Diabetes Care 20:1183-1197, 1997 7 National Diabetic Data Group: Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance Diabetes 28: 1039-1057, 1979
GESTATIONAL DIABETES MELLITUS
Who should be screened? Risk assessment for Gestational Diabetes Mellitus GDM should be undertaken at the first prenatal visit Women with clinical characteristics consistent with a high risk of GDM marked obesity, personal history of GDM, glycosuria, or a strong family history of diabetes should undergo glucose testing as soon as feasible If they are not found to have GDM at that initial screening, they should be retested between 24 and 28 weeks of gestation Women of average risk should be tested at 24 - 28 weeks gestation Women of low risk status require no glucose testing, but this category is limited to those women meeting all of the following: 25 years of age, normal weight before pregnancy, member of an ethnic group with a low prevalence of GDM, no sibling or parent known to have diabetes, no history of abnormal glucose tolerance and no history of poor obstetric outcome
SCREENING FOR GESTATIONAL
DIABETES MELLITUS
A fasting plasma glucose level 126 mg/dL 70mmol/L or a casual random plasma glucose level 200 mg/dL 111 mmol/L that are confirmed on a subsequent day meet the threshold for the diagnosis of diabetes and precludes the need for any glucose challenge
One -Step Approach: Perform a diagnostic oral glucose tolerance test OGTT without prior plasma or serum glucose screening This approach may be cost-effective in high-risk patients or populations Use either the 75 gram or 100 gram OGTT described below
Two -Step Approach: Perform an initial screening by measuring the plasma or serum glucose concentration 1 hour after a 50 gram oral glucose load Those who exceed the glucose threshold value of 140 mg/ dl 78 mmol/l identify approximately 80 of women with GDM Those who exceed the glucose threshold value of 130 mg/dl 72 mmol/l identify approximately 90 of women with GDM Perform either the 75 gram or 100 gram OGTT on those who fail the initial screening
100-gram Oral Glucose Load OGTT modified criteria Sample mg/dL mmol/L Fasting 95 53 1-hr 180 100 2-hr 155 86 3-hr 140 78 ———————————————————————–Two or more of the venous plasma
results must be met or exceeded for a positive diagnosis The test should be done in the morning after an overnight fast of 8 - 14 hours and after at least 3 days of unrestricted diet 150 gms carbohydrates per day and unlimited physical activity The subject should remain seated and should not smoke throughout the test
75-gram Oral Glucose Load OGTT Sample mg/dL mmol/L Fasting 95 53 1-hr 180 100 2-hr 155 86 ——————————————————————————–Two or more of the venous plasma concentrations must be met or exceeded for a positive diagnosis The test should be done in the morning after an overnight fast of 8 - 14 hours and after at least 3 days of unrestricted diet 150 gms carbohydrates per day and unlimited physical activity The subject should remain seated and should not smoke throughout the test This test is not as well validated as the 100gm OGTT
Source:doh.wa.gov
