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
- Diagnosis and classification of diabetes mellitus.
- Diagnosis and Classification of Diabetes Mellitus
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.
Report of the Committee on the classification and diagnostic criteria 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. In addition, long-term complications such as retinopathy, neuropathy, nephropathy, and cardiovascular disease can be minimized if blood glucose levels are effectively controlled.
Hemoglobin A1c HbA1c is a result of the nonenzymatic attachment of a hexose molecule to the N-terminal amino acid of the hemoglobin molecule. The attachment of the hexose molecule occurs continually over the entire life span of the erythrocyte and is dependent on blood glucose concentration and the duration of exposure of the erythrocyte to blood glucose. Therefore, the HbA1c level reflects the mean glucose concentration over the previous period approximately weeks, depending on the individual and provides a much better indication of long-term glycemic control than blood and urinary glucose determinations.
Diabetic patients with very high blood concentrations of glucose have from 2 to 3 times more HbA1c than normal individuals. The threshold is based upon sensitivity and specificity data from several studies. Patients who have an HbA1c between 5. The terms prediabetes, impaired fasting glucose, and impaired glucose tolerance will eventually be phased out by the ADA to eliminate confusion.
The ADA recommends measurement of HbA1c typically times per year for type 1 and poorly controlled type 2 diabetic patients, and 2 times per year for well-controlled type 2 diabetic patients to determine whether a patient's metabolic control has remained continuously within the target range.
The ADA recommendations for clinical practice suggest maintaining a HbA1c value closer to normal yields improved microvascular outcomes for diabetics. Since the HbA1c assay reflects long-term fluctuations in blood glucose concentration, a patient with diabetes who has come under good control in recent weeks may still have a high concentration of HbA1c.
The converse is true for a patient with diabetes previously under good control who is now poorly controlled. HbA1c results less than 4. HbA1c may not accurately reflect glycemic control when clinical conditions that affect erythrocyte survival are present.
Fructosamine may be used as an alternate measurement of glycemic control. The presence of hemoglobin variants can interfere with the measurement of hemoglobin A1c HbA1c. The advantage of using ion exchange chromatography methods is most variants that would affect HbA1c results can be detected from analysis of the chromatogram so inaccurate results are less likely to be reported.
If the specimen cannot be analyzed due to a homozygous variant or other interference, measurement of serum fructosamine may be helpful to monitor glycemic control. Some hemoglobinopathies can be associated with reduced red blood cell lifespan and any measured HbA1c concentration would not provide a true measurement of the patient's glycemic control and could lead to misinterpretation.
In such situations, fructosamine should be used as an alternate measurement of glycemia and is recommended for monitoring these patients. In cases of hemolytic anemia, the lifetime of erythrocytes is shortened and will result in decreased HBA1c results.
This effect will depend upon the severity of the anemia. Specimens from patients with polycythemia or postsplenectomy may exhibit increased HBA1c values due to a somewhat longer lifespan of the erythrocytes.
Caution should be exercised when interpreting the HbA1c results from patients with these conditions. Diabetes Care. National Academy of Clinical Biochemistry. Hb A1c. In: Sacks DB, ed. Clin Biochem.
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Diagnosis and classification of diabetes mellitus.
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. In this paper, we will define problems of HbA1c and the international challenge in the future, referring to the history of the diagnosis of 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.
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.
Diagnosis and Classification of Diabetes Mellitus
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.
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DEFINITION AND DESCRIPTION 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.