DM - Diagnosis

Question 1

What has the highest Evidence rating and grade according to the American Association of Clinical Endocrinologists & American College of Endocrinology Clinical Practice Guidelines for managing Diabetes Mellitus?

Answer 1

Meta-analysis of randomized controlled trials (MRCT)

Question 2

Age for Screening criteria for DM II & Pre-DM II in Asymptomatic adults

Answer 2

Age ≥45 years without other risk factors

Question 3

BMI Screening criteria for DM II & Pre-DM II in Asymptomatic adults

Answer 3

• BMI ≥30 kg/m2
• BMI 25-29.9 kg/m2 plus other risk factors*

Question 4

Dyslipidemia Screening criteria for DM II & Pre-DM II in Asymptomatic adults

Answer 4

• HDL-C <35 mg/dL
• Triglycerides >250 mg/dL

(longer list on slide 16)

Question 5

Screen at-risk individuals with normal glucose values every ___ years

Answer 5

3

Question 6

Consider annual screening of DM II for patients
with ____+ risk factors

Answer 6

2

Question 7

Diagnostic Laboratory Tests for Prediabetes & Diabetes II in Non-pregnant Adults

Answer 7

Urine Glucose – unreliable for diagnosis
Urine & Blood Ketones
* >0.6 mmol/L requires evaluation
* >3.0 mmol/L requires hospitalization
Plasma or Serum Glucose
* ≥ 126 mg/dL on two separate occasions with at least 8 hours of
fasting is diagnostic for Diabetes Mellitus

Question 8

How is Whole Blood Glucose Level measured?

Answer 8

• Quantitative, hand-held meter & reagent test strip measure glucose*
• GDH-PQQ (glucose dehydrogenase pyrroloquinoline quinone) test strips
• *Note cannot distinguish between glucose & certain non-glucose sugars (maltose, xylose, galactose) → falsely ↑ BG

Question 9

T/F Oral Glucose Tolerance Test (GTT) should be done in the morning

Answer 9

T

Question 10

Diagnostic Values for DM (Non-fasting) - HgbA1c

Answer 10

• ≥ 6.5% & fasting plasma glucose >126 mg/dL
• ≥ 6.5% & random plasma glucose > 200 mg/dL
• ~5.7-6.4% indicates higher risk (prediabetes or insulin resistance)

Question 11

T/F A1C should be considered an additional, optional diagnostic criterion and NOT the primary criterion for diagnosis of diabetes

Answer 11

T

Question 12

T/F A1C is recommended for diagnosing type 1 diabetes and gestational diabetes

Answer 12

F

Question 13

Type 1 Diabetes Diagnostic Criteria - – Type 1a, Immune Mediated

Answer 13

• Document levels of insulin & C-peptide
• Test for autoantibodies* (GAD, tyrosine phosphatase IA-2)
• Typically positive for HLA-DR3, 4, or 9 antigens
• May occur in overweight or obese as well as lean individuals

Question 14

Type 1 Diabetes Diagnostic Criteria - Type 1b, Non-immune Mediated

Answer 14

• Document levels of insulin & C-peptide
• Usually idiopathic
• Strongly inherited
• No immunological evidence for β-cell autoimmunity and no HLA
  association

Question 15

Diagnostic Criteria for Gestational Diabetes

Answer 15

Screen at 24-28 weeks gestation
Fasting Plasma Glucose >92 mg/dL
1-h Plasma Glucose ≥180 mg/dL
2-h Plasma Glucose ≥153 mg/dL

Question 16

Why would it be beneficial to be able to diagnose glucose with high specificity/sensitivity with a single blood sample as opposed to two?

Answer 16

Requiring return visits can be inconvenient and costly and may delay patient care