diagnosis of diabetes

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quackdoc

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what are the revised criteria of diabetes?the 15th edition of harrisons says that fasting glucose levels are the sole criteria with values upto 200mg/dl on random,126mg/dl on fasting blood glucose +symptoms of diabetes,oral glucose tolerance test values more than 200 mg/dl
could the doctors in states please confirm from the following toll free number?
National Diabetes Information Clearinghouse (NDIC) at 1-800-860-8747
thanks for the same.
The values on the web site for the same are different from the ones quoted above.

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Here is the most current reccomendations from the American Diabetes Association (which is responsible for coming up the consensus guidelines here in the states) regarding diabetes diagnosis:

"1. Symptoms of diabetes plus casual plasma glucose concentration 200 mg/dl (11.1 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.
or
2. FPG 126 mg/dl (7.0 mmol/l). Fasting is defined as no caloric intake for at least 8 h.
or
3. 2-h postload glucose 200 mg/dl (11.1 mmol/l) during an OGTT. The test should be performed as described by WHO, using a glucose load containing the equivalent of 75 g anhydrous glucose dissolved in water. "


http://care.diabetesjournals.org/cgi/content/full/27/suppl_1/s5
http://www.guideline.gov/summary/summary.aspx?doc_id=3523&nbr=2749
http://care.diabetesjournals.org/cg...5fbf5438d7e6ef4dabda9157&keytype2=tf_ipsecsha

I believe that the main changes that have been instituted in the past few years is a new classification of pre-diabetes or impaired glucose tolerance:

Impaired glucose tolerance (IGT) and impaired fasting glucose (IFG)
The Expert Committee (1,2) recognized an intermediate group of subjects whose glucose levels, although not meeting criteria for diabetes, are nevertheless too high to be considered normal. This group is defined as having fasting plasma glucose (FPG) levels 100 mg/dl (5.6 mmol/l) but <126 mg/dl (7.0 mmol/l) or 2-h values in the oral glucose tolerance test (OGTT) of 140 mg/dl (7.8 mmol/l) but <200 mg/dl (11.1 mmol/l). Thus, the categories of FPG values are as follows:

FPG <100 mg/dl (5.6 mmol/l) = normal fasting glucose;

FPG 100?125 mg/dl (5.6?6.9 mmol/l) = IFG (impaired fasting glucose);

FPG 126 mg/dl (7.0 mmol/l) = provisional diagnosis of diabetes (the diagnosis must be confirmed, as described below).

The corresponding categories when the OGTT is used are the following:

2-h postload glucose <140 mg/dl (7.8 mmol/l) = normal glucose tolerance;

2-h postload glucose 140?199 mg/dl (7.8?11.1 mmol/l) = IGT (impaired glucose tolerance);

2-h postload glucose 200 mg/dl (11.1 mmol/l) = provisional diagnosis of diabetes (the diagnosis must be confirmed, as described below). "
 
Thanks for the reply Kalel.
The values are fine.But is there any room for glycosylated haemoglobin also?
I came across this somewhere that most of the diabetes patients donot manifest the symptoms of diabetes always.
In that case is the glycosylated haemoglobin a true indicator of the diabetes even though the symptoms have not manifested?How long does it take to manifest the symptoms...the median age at which the patient turns symptomatic?
 
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i believe also a hemoglobin a1c of over 6.0 is indicitive of diebetes....and is there to tell you if there was an outbreak within 3 months.
Glucose should not attach itself to the hemoglobin for that long unless it had no place else to go (hyperglycemia)
They do say however, that that test is more for those that are ALREADY diagnosed with diabetes.....not used to make the actual diagnosis.
 
Originally posted by quackdoc
Thanks for the reply Kalel.
The values are fine.But is there any room for glycosylated haemoglobin also?
I came across this somewhere that most of the diabetes patients donot manifest the symptoms of diabetes always.
In that case is the glycosylated haemoglobin a true indicator of the diabetes even though the symptoms have not manifested?How long does it take to manifest the symptoms...the median age at which the patient turns symptomatic?

Using HbA1 is a less sensitive test (you would miss more diabetics) then using a fasting glucose as a test. Checking a glucose level is also cheaper then checking a HbA1C level too; most physicians order a chem-7 with patients who are on medication for things like blood pressure or hyperlipidemia (glucose level is included in a chem-7). Some physicians do use HbA1C as a screening test in private practice though. As for the symptoms, it depends on what type of diabetes you are talking about. Type II diabetes is particularly nasty because a lot of the pathology and organ damage is done before a person is labeled "diabetic" or symptomatic, that's one of the reasons that they wanted to create this new impaired glucose labeling. Type I diabetes can present somewhat insidiously too, with patients just not noticing that they are drinking and urinating more, or it's first symptom can be a sudden presentation of diabetic ketoacidosis. Type I diabetes peak incidence age is 11-13, while type II usually presents in patients 40 or older. The incidence of type II diabetes is increasing though (many teenagers are getting this diagnosis these days), and type I diabetes can present in middle aged adults as well (30-40's).
 
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