Screening for Diabetes. There is a difference between diagnostic testing and screening. identify asymptomatic individuals who are likely to have diabetes. …
Diabetes Resources
Practical Information for New Mexico Health Care Professionals
PO Box 3548 Albuquerque, NM 87190 866 796-9121 505 796-9121 A quarterly publication for clinicians caring for people with diabetes - Vol 5 No 3, 2005 Vol
In each issue of Diabetes Resources we have provided specific information about management for diabetes, including important tests and resources to help reduce complications associated with the disease Information is included about the ABCs of diabetes: A1C testing 2-4 times per year, Blood pressure screening at every visit, and annual Cholesterol testing Additional clinical information is also provided A dilated eye exam, sensory foot exam and screening for kidney disease each recommended annually Attention to these risk factors reduces the chance for cardiac, renal, eye and vascular disease secondary to diabetes In support of the New Mexico Diabetes Practice Guideline 2005, please see the reverse side of Diabetes Resources for recommendations for care including resources and tools that can help in your efforts to provide education and support among your patients with diabetes
Diabetes Screening
The Issue:
Diabetes is frequently underdiagnosed
Earlier diagnosis of diabetes may lead to reduced long-term complications Patients with risk factors should be screened when clinically appropriate
Did you know?
The Fasting Plasma Glucose is the preferred diagnostic test because of its ease of administration, convenience, acceptability to patients and lower cost
Screening for Diabetes
There is a difference between diagnostic testing and screening When an individual exhibits symptoms or signs of a disease, diagnostic tests are performed These tests are not considered to be screening tests Rather, the purpose of screening is to identify asymptomatic individuals who are likely to have diabetes
Asymptomatic, undiagnosed individuals who have the following risk factors are at increased risk for undiagnosed diabetes and should be screened for diabetes whenever clinically appropriate1, 2 Table 1: Risk Factors for Diabetes
Modifiable Risk Factors
Hypertension Dyslipidemia HDL35 mg/dl and/or fasting TG250 mg/dl1 Overweight/Obesity BMI25 kg/m21 Physical inactivity1, 2
Unmodifiable Risk Factors
First-degree relative with diabetes1 Polycystic ovarian syndrome PCOS1 History of impaired glucose tolerance 100125 mg/dl or impaired fasting
plasma glucose FPG126 mg/dl1, 2 Conditions associated with insulin resistance acanthosis nigricans1 Gestational diabetes or delivered a baby weighing 9 lbs
The American Diabetes Association recommends that screening be considered in all individuals at age 45 years and above and, if normal, should be repeated at three-year intervals1 Consideration for earlier or more frequent screening may be given to patients who are members of a high-risk ethnic population African American, Hispanic, Native American, Asian
Check wwwnmtodcom for organizations that have graciously provided funding for Diabetes Resources New Mexico Health Care Takes On Diabetes is a broad coalition of New Mexicos diabetes care professionals, New Mexico Health Plans, the New Mexico Department of Health, and the New Mexico Medical Review Association, with technical and administrative support from the American Diabetes Association
Establishing a Diagnosis of Diabetes
While there are other methods, the two easiest methods for establishing the diagnosis of diabetes are shown in Table 2 In the absence of unequivocal hyperglycemia, these tests must be confirmed on a subsequent day The ADA does not recommend the use of
the A1C for the diagnosis of diabetes Table 2: Two Methods for Diagnosing Diabetes
1 Symptoms of diabetes plus casual plasma glucose concentration 200 mg/dl 111 mmol/l Casual 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 2 FPG 126 mg/dl 70 mmol/l Fasting is defined as no caloric intake for at least 8 h
1 2
Diabetes Care January 2005, Supplement 1; S5-S6 The Guide to Clinical Preventive Services 2005; Recommendations of the US Preventative Services Task Force, Agency for Healthcare Research and Quality; Screening for Type 2 Diabetes Mellitus in Adults; pages 128- 131
Resources for Clinicians
The following resources are FREE and can be downloaded from the New Mexico Health Care Takes On Diabetes website at wwwnmtodcom For further information contact Charm Lindblad, Executive Director, at 5057969121 or toll-free 18667969121
Editorial Committee:
Patty Anello, RN, BSN Jeanine Ertel, MPH Mary Fluckey, MS, CHES, CPHQ M L Johnston, MS, RD, CDE Charm Lindblad, MHA Bruce A Mann, MD, FACP Erin McDonald Bicknell Sharon Notah-White Willa Pilár Stephen Ryter, MD, FAAP Leslie
Shainline, RN, MS Laura Valdez, RN, BSN
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How to Interpret the A1C–A1C is the most important indicator of glucose control in diabetes, but it can be difficult to interpret the clinical relevance of an A1C value The goal is an A1C 70, but do you know why? Did you know an A1C level of 90 equates to an average glucose level of 240 mg/dl? Do you know how to interpret the A1C when patients have repeated episodes of hypoglycemia or when they are anemic? How to Interpret the A1C will help answer those questions and will show you how A1C levels relate to average blood glucose levels and clinical complications This memory jogger for clinicians can be downloaded for free from the New Mexico Health Care Takes On Diabetes website A Screening Tool for Your Patients–People over the
Graphic Layout: Anna Dykeman, MA New Mexico Medical Review Association
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3548 PO Box NM 87190 1 erque, Albuqu 866 796-912 1 505 796-912
age of 45 years should
be screened for type 2 diabetes For those under 45 years old, screening will depend on whether other risk factors are present According to the National Institutes of Health, one or more yes answers indicates risk for type 2 diabetes Help your patients take this simple quiz to determine their risk for type 2 diabetes
Advisory Board:
Mark Burge, MD Assoc Prof- Medicine,Endocrinology and Metabolism/Director of Clinical Trials Department of Medicine and Endocrinology UNM Health Sciences Center Nathaniel G Clark, MD, MS, RD National VP Clinical Affairs , American Diabetes Association Donna Tomky, MSN, RN, C-ANP, CDE Nurse Practitioner, Dept of Endocrinology Diabetes, Lovelace Sandia Medical Center Judith Gabriele, MPH Program Manager, Diabetes Prevention and Control Program, New Mexico Department of Health Jeremy Gleeson, MD, FACP, CDE Medical Director, Endocrinology, Lovelace Health Systems
Websites–The editorial committee has identified websites that you may find informative: National Diabetes Education Program: wwwndepnihgov
American Diabetes Association: wwwdiabetesorg National Institutes of Health: wwwdiabetesniddknihgov American Heart Association, Heart of Diabetes Program:
wwwamericanheartorg/diabetes NM Department of Health, Diabetes Prevention and Control Program: wwwdiabetesnmorg Information about Diabetes Testing: ADA Clinical Practice Recommendations 2005, supplement 1, Diabetes Care January 2005 Vol 28 wwwdiabetesorg/DIABETESCARE Diet, Nutrition and Weight Control www5adaygov wwwhealthychoicesorg wwwusdagov/cnpp HTN and Diabetes: wwwdiabetesorg/makethelink These websites may be accessed directly or through the New Mexico Health Care Takes On Diabetes website wwwnmtodcom
Please note that these websites do not necessarily represent the views of NMHCTOD They are listed for your reference and convenience NMHCTOD does not evaluate websites for content accuracy or application to any clinical situation
Copyright 2005 by New Mexico Health Care Takes On Diabetes May be reproduced without restriction in New Mexico and for educational purposes Permission for other use outside New Mexico may be obtained at 5057969121 These materials were developed under a contract with the State of New Mexico, Department of Public Health, Division of Public Health
Printed 2005
Source:lionsclubs.org
