Diabetes Mellitus Classification - PowerPoint Presentation

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Diabetes MellitusClassification and Diagnosis

Hengameh Abdi, MDEndocrine Research Center Research Institute for Endocrine Sciences Shahid Beheshti University of Medical Sciences28 October 2015abdi@endocrine.ac.ir

WORLD387

millionWORLD592million people living with diabetes

Middle East and North Africa 85%

South East Asia 64

%

South and Central

America 55%

Western Pacific 46

%

North America and Caribbean 30

%

Europe 33

%

Africa 93

%

53%

Diabetes is a huge and growing problem…

MIDDLE EAST AND NORTH AFRICA at a glance

36.8 million people

have diabetes -

1 in 10 adults

3% of worldwide

expenditure

- USD 16.8 billion

Prevalence of Diabetes in Iran: 8.64%

Classification:1. Type 1 diabetes

(due to β-cell destruction, usually leading to absolute insulindeficiency)2. Type 2 diabetes (due to a progressive insulin secretory defect on the backgroundof insulin resistance)3. Gestational diabetes mellitus (GDM) (diabetes diagnosed in the second or thirdtrimester of pregnancy that is not clearly overt diabetes)4. Specific types of diabetes due to other

causes:Monogenic diabetes

syndromes

(such as…)

Maturity-onset

diabetes of the young

(MODY)

Lipodystrophic syndromes

Neonatal diabetes Diseases of the exocrine pancreas (such as…) Cystic fibrosis Pancreatitis

Drug- or chemical-induced diabetes (such as…) Glucocorticoids, drugs

in the treatment of HIV/AIDS or after organ transplantation

Spectrum of glucose homeostasis

NGSP: National Glycohemoglobin Standardization Program FPG: Fasting Plasma Glucose

DCCT: Diabetes Control and Complications Trial OGTT: Oral Glucose Tolerance Test

Criteria for the diagnosis of diabetes: A1C ≥6.5%

The

test should be

performed in

a laboratory using a method that

is NGSP

certified and standardized to the DCCT assay.*OR

FPG ≥126 mg/dL (7.0 mmol/L) Fasting is defined as no caloric intake for at least 8 h.*OR2-h PG ≥200 mg/dL (11.1 mmol/L)

during an OGTT The test should be performed as described by the WHO, using a glucose load containing the equivalent of 75 g anhydrous glucose dissolved in water.*

ORIn a patient with classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma glucose ≥200 mg/dL (11.1 mmol/L)*In the absence of

unequivocal hyperglycemia, results should be confirmed by repeat testing. It is recommended that the same test be repeated immediately; If two different tests (such as A1C

and FPG) are both above the diagnostic threshold, this also confirms the diagnosis.

Criteria for testing for diabetes or prediabetes in asymptomatic adults

1. Testing should be considered in all adults of any age who are overweight (BMI ≥25 kg/m2 or ≥23 kg/m2 in Asian Americans) and have additional risk factors:physical inactivityfirst-degree relative with diabetes

high-risk race/ethnicity (e.g., African American, Latino, Native American, Asian American, Pacific Islander)women who delivered a baby weighing

>9

lb or were diagnosed with GDM

hypertension (≥140/90

mmHg or on therapy for hypertension)

HDL

cholesterol

level <35 mg/dL (0.90 mmol/L) and/or a triglyceride

level >250 mg/dL (2.82 mmol/L)women with polycystic ovary syndromeA1C ≥5.7%, IGT, or IFG on previous testingother clinical conditions associated with insulin resistance (e.g., severe obesity, acanthosis nigricans)history of CVD

Criteria for testing for diabetes or prediabetes in asymptomatic adults (cont…)

2. For all patients, particularly those who are overweight or obese, testing should begin at age 45 years.3. If results are normal, testing should be repeated at a minimum of 3-year intervals, with consideration of more frequent testing depending on initial results (e.g., those with prediabetes should be tested yearly) and risk status.

*Persons aged <18 yearsTesting for type 2 diabetes or prediabetes

in asymptomatic children*CriteriaOverweight (BMI >85th percentile for age and sex, weight for height >85th percentile, or weight >120% of ideal for height)Plus any two of the following risk factors:Family history of type 2 diabetes in first- or second-degree relativeRace/ethnicity (Native

American, African American, Latino, Asian American, Pacific Islander)Signs of insulin resistance

or conditions

associated with

insulin resistance

(acanthosis

nigricans, hypertension

,

dyslipidemia, polycystic ovary syndrome, or small for-gestational-age birth weight)

Maternal history of diabetes or GDM during the child’s gestationAge of initiation: age 10 years or at onset of puberty, if puberty occurs at a younger ageFrequency: every 3 years

Testing for Type 1 Diabetes:Inform the relatives of

patients with type 1 diabetes of the opportunity to be tested for type 1 diabetes risk (measuring islet autoantibodies), but only in the setting of a clinical research study. E

Test for undiagnosed type 2 diabetes at the first prenatal visit in those with risk factors, using

standard diagnostic criteria. BGestational Diabetes

Screening for and diagnosis of Gestational DM (GDM), if not previously known to have diabetes

One-step strategy:

Screening for and diagnosis of Gestational DM (GDM), cont…

Two-step strategy:

Maturity-onset diabetes of the young (MODY)

It is inherited in an autosomal dominant pattern.Impaired insulin secretion with minimal or no defects in insulin action. Onset of hyperglycemia at an early age (generally before age 25 years).The diagnosis of monogenic diabetes should be considered in children

with the following findings:Strong family history of diabetes

but without

typical features of type 2

diabetes (nonobese

, low-risk

ethnic group

)

Mild fasting hyperglycemia (100–150 mg/dL [5.5–8.5mmol/L]), especially

if young and nonobeseDiabetes with negative autoantibodies and without signs of obesity or insulin resistance

Latent autoimmune diabetes in adults (LADA)A

slowly progressive form of autoimmune or type 1 diabetes that can be treated initially without insulin injections.The diagnosis of LADA is currently based on three criteria:Adult age at onset of diabetes.The presence of circulating islet autoantibodies. (

Distinguishes LADA from type 2 diabetes)

L

ack

of a

requirement for

insulin for at least 6 months after

diagnosis.

(

Distinguishes LADA from classic type 1 diabetes)Fourlano S. Diabetologia (2005) 48: 2206–2212

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