Classification and Diagnosis of Dm Isd Workshop 2014

7/24/2019 Classification and Diagnosis of Dm Isd Workshop 2014

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DIAGNOSIS ANDCLASSIFICATION OFDIABETES MELLITUS

LEILANI A. BALDEVISO, M.D.,DPCP

INTERNAL MEDICINE-DIABETES

ISDFI-FACULTY


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Learning Obje!i"e#

Defne the criteria or diagnosingDefne the criteria or diagnosing

diabetesdiabetes

Enumerate and dierentiate theEnumerate and dierentiate thetypes o diabetestypes o diabetes

Identiy patient risk actors orIdentiy patient risk actors or

diabetesdiabetes Cite screening recommendationsCite screening recommendations

or patients at riskor patients at risk


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A $e!ab%&i'i#%r'er (re#ene %) *+(erg&+e$ia

'e !% 'e)e!i"e in#&in #ere!i%n, in#&in

a!i%n %r b%!* re#&!ing in 'e)e!# in arb%*+'ra!e,

(r%!ein an' )a! $e!ab%&i#$.

Associated with long-term seuelaeAssociated with long-term seuelaeaecting! kidney" eye" ner#es" heart andaecting! kidney" eye" ner#es" heart and

blood #essels$blood #essels$


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Re"i#i%n# in Diabe!e# C&a##ia!i%nTer$in%&%g+

/0/-- NDDG //1---ADA

T*e !er$2j"eni&e

%n#e!3 an' 2 a'&!%n#e!3 'iabe!e#4ere 'i#ar'e' a#ina((r%(ria!e an'

re!er$e' 2in#&in-'e(en'en! 'iabe!e#$e&&i!# 5IDDM63an' 2n%n-in#&in-'e(en'en! 'iabe!e#

$e&&i!# 5NIDDM63,

T*e !er$# 2 in#&in- 'e(en'en!3 an' 2n%n-

in#&in- 'e(en'en! an' !*eirar%n+$#

4ere e&i$ina!e' a#%n)#ing

an' !rea!$en!-ba#e'ra!*er !*e

e!i%&%g+-ba#e'

T*e !er$# 2!+(e 3

an'!+(e 73 'iabe!e#

4erere!aine', #ing

arabi

n$era ra!*er!*an


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2T8E DIABETICS OF TOMORRO99ILL COME FROM T8E C8ILDREN OF

TODAY3


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Diabetes Prevalence in the Philippines


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C&a##i S+$(!%$# %)

Diabe!e# %olyuria%olyuria

%olydipsia%olydipsia &ne'plained weight loss&ne'plained weight loss

(eport o the E'pert Committee on the Diagnosis and Classifcation o Diabetes )ellitus$

Diabetes Care *++, *./0uppl 12!s3-s*+


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Diagn%#i# %) Diabe!e#


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Suggested Algorithm forSuggested Algorithm for

Diagnosing DiabetesDiagnosing Diabetes

Based on: Report of the Expert Committee on theBased on: Report of the Expert Committee on the

Diagnosis and Classification of Diabetes Mellitus.Diagnosis and Classification of Diabetes Mellitus.

Diabetes Care 2003 2!"#uppl $%: s$2 &D&.Diabetes Care 2003 2!"#uppl $%: s$2 &D&.

#creening for '(pe 2 Diabetes. Diabetes Care 2003#creening for '(pe 2 Diabetes. Diabetes Care 2003

2!"#uppl $%: s2$)s2*%2!"#uppl $%: s2$)s2*%


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33%33%NormalNormal

33%33%IGTIGT

33%33%DMDM


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Prediabetes


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Classification of DiabetesClassification of Diabetes

Type 1 diabetes -cell destruction

Type 2 diabetes

Progressive insulin secretory defect

Other specific types of diabetes

Genetic defects in -cell function, insulin action

Diseases of the exocrine pancreas

Drug- or cheical-induced

Gestational diabetes ellitus !GD"#

$D$% &% 'lassification and Diagnosis% Diabetes 'are 2(1)*+!suppl 1#.1)


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(eport o the E'pert Committee on the Diagnosis

and Classifcation o Diabetes )ellitus$ DiabetesCare *++, *./0uppl 12!s3-s*+

T+(e Diabe!e#

(esults rom autoimmune destructiono pancreatic beta-cells

Absolute insulin defciency

%atients typically dependent on insulin

or sur#i#al

%atients may present with ketoacidosis

as initial sign o the disorder


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(eport o the E'pert Committee on the Diagnosisand Classifcation o Diabetes )ellitus$ DiabetesCare *++, *./0uppl 12!s3-s*+

T+(e 7 Diabe!e#

Insulin resistance and relati#e insulindefciency

%atients may or may not need insulin

treatment to sur#i#e )ay remain undiagnosed or many years" as

hyperglycemia de#elops slowly

Associated with strong genetic predispositio 4eterogenous


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G&%#e5$g:'&6

1; ;;

1;

7;;

71;

DeGr%%! an' >L >a$e#%n. P*i&a'e&(*ia? 9.B. San'er# C%., 7;;.Origina&&+ (b&i#*e' in Type 2 Diabetes BASICS. 5In!erna!i%na& Diabe!e# Cen!er, Minnea(%&i#, 7;;;6.

Re&a!i"e)n!i%n

5@6

Fa#!ingg&%#e

ObesityObesity IFGIFG DiabetesDiabetesUncontrolledUncontrolled

hyperglycemiahyperglycemia

In#&in re#i#!ane

P%#!-(ran'ia&g&%#e

In#&in #ere!i%nClinicalClinicaldiagnosisdiagnosis

Natural History of Type 2 DiabetesNatural History of Type 2 Diabetes


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(eport o the E'pert Committee on the Diagnosis and Classifcation o Diabetes )ellitus$ Diabetes Care *++,

*./0uppl 12!s3-s*+

Ge#!a!i%na& Diabe!e# Me&&i!#

5GDM6 Any degree o glucose intolerance with

onset or frst recognition during

pregnancy Associated with increased perinatal

morbidity and mortality

. weeks or more ater pregnancy ends"the woman should be reclassifed

4igh risk or type * D)$


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(eport o the E'pert Committee on the Diagnosis and Classifcation o Diabetes )ellitus$ Diabetes Care *++,

*./0uppl 12!s3-s*+

Ge#!a!i%na& Diabe!e# Me&&i!#5GDM6

RIS FACTORS5Maternal age + 3, (ears5Mar-ed obesit(5ersonal histor( of /DM

5reious infant + * -g5re)diabetes5/l(cosuria5#trong famil( histor( of DM51(pertension before pregnanc(

or in earl( pregnanc(5Ethnicracial group ith high prealence of DM "&frican)&mericans4 &sian)&mericans4 1ispanic)&mericans4 5atie

&mericans4 acific 6slanders%


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DETECTION AND DIAGNOSISDETECTION AND DIAGNOSISOF GESTATIONAL DIABETESOF GESTATIONAL DIABETES

MELLITUS (GDM)MELLITUS (GDM)


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Routine Prenatal Care ScreeningTwo Step Approach

50 gm random

oral glucose load

!hour plasma glucose

measurement

"#$0 mg%dl

00 &RA'S

(&TT

1st

step

2nd step

GDM Di i


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GDM Diagn%#i#

7 A((r%a*e# )%r Diagn%#ing Ge#!a!i%na& Diabe!e# Me&&i!# 5GDM6AACE- and ADA-recommended

1-step 63-g *-hour oral glucose tolerance test /789921"*or

AC78-recommended

* steps! a 3+-g 1-hour glucose challenge test /8C92" ollowed bya 1++-g ,-hour 7899 /i necessary2,

GDM Diagnostic Criteria for OGTT Testing7,)g 2)hour8 $00)g 3)hour9

asting plasma glucose"/%

;0 mgd= "$0.0 mmol=%2 ;$>0 mgd= "$0.0 mmol=%2

2)hour post)challengeglucose

;$,3 mgd= ">., mmol=2 ;$,, mgd= ">.! mmol=%2

3)hour post)challengeglucose

;$*0 mgd= "7.> mmol=%2

8& positie diagnosis re?uires that test results satisf( an( one of these criteria9& positie diagnosis re?uires that ;2 thresholds are met or exceeded

1.AACE.Endocr Pract

. 2011;17(2):1-53.2.ADA.Diabetes Care. 2013;36(suppl 1):11-66.3.Committee on Obstetric Practice. ACOG. 2011;504:1-3.


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TESTING FOR DIABETES INTESTING FOR DIABETES INASYMTOMATIC ATIENTSASYMTOMATIC ATIENTS


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% ge! a gre %) ;;-71$g:'&, +% are 4i!e range %) IFG --- a %n'i!i%n 4*i* $a+ !aei!!&e !i$e !% 'e"e&%( in!% )ran 'iabe!e#. In #a#e %n#&! a %$(e!en! 'iabe!e# &ini


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I) +% ge! a gre %) 7$g:'& an'%"er, %n#&!

a %$(e!en! 'iabe!e# &ini )%r%nr$a!i%n

an' !rea!$en!. Y% (r%bab&+ are'iabe!i.


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T*e be#! 4a+ !% (re"en! 'iabe!e# in*ig* ri#

in'i"i'a an' !% (re"en!%$(&ia!i%n# a$%ng

%nr$e' 'iabe!i# i# !% %n#i#!en!&+ee(

FBS be&%4 ;; 7$g:'& re#(e!i"e&+an' PBG be&%4 =;$g:'&.


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Eeri#e 'ai&+

D%n! ge! )a! %r %"er4eig*!

ee( in !%* 4i!* a g%%' 'iabe!e# &in

%i' #4ee!#, #a&!, )a!, a&%*%& an' igare


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I!" RE!ENTION#DELAY OFI!" RE!ENTION#DELAY OFTYE $ DIABETESTYE $ DIABETES


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ADA 7;;/? E(er! C%$$i!!ee Re%$$en'# U#e%) 8e$%g&%bin AC )%r Diagn%#i# %) Diabe!e#

:une 6" *++; /" and EA0D ?oined orces to

recommend the use o A1c assay or thediagnosis o diabetes

Diagnostic #alue o @.$3

9his cut-point is where risk oretinopathy substantially increases

Cri!eria )%r !*e Diagn%#i# %)Cri!eria )%r !*e Diagn%#i# %)


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Cri!eria )%r !*e Diagn%#i# %)Cri!eria )%r !*e Diagn%#i# %)

Diabe!e#Diabe!e#

AC H.1@

9he test should be perormed in alaboratory using an


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Pre'iabe!e#? IFG, IGT, Inrea#e'Pre'iabe!e#? IFG, IGT, Inrea#e'ACAC

Ca!eg%rie# %) inrea#e' ri# )%r 'iabe!e#5Pre'iabe!e#6

>%8 1++-1*3 mgdl /3$.-.$; mmoll2! I>8

or

*-h plasma glucose in the 63-g 78991+-1;; mgdl /6$F-11$+ mmoll2! I89

or

A1C 3$6-.$

>or all three tests" risk is continuous" e'tending below the lower limit o a range and becomingdisproportionately greater at higher ends o the range$

$D$% &% 'lassification and Diagnosis% Diabetes Care 2(11*+)!suppl 1#.1+% Table +%

Cl ifi ti f D


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Classification of D

NDDG !"#$#%

"& D Type I' Insulin'dependent diabetes mellitus

!IDD%

2& Type II Non'insulin'

dependent D !NIDD%

(& Gestational diabetes

)& alnutrition related diabetes

*& Other type of D

Impaired glucose tolerance

!IGT%

'

+D+ !"##$%

"& Type " diabetes!'cell

destruction%

a& Immune mediated

b& Idiopathic

2& Type 2 diabetes !insulin

resistance , insulin

deficient%

(& Gestational diabetes

)& Other specific types

C& i i ) Di b


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C&a##ia!i%n %) Diabe!e#C&a##ia!i%n %) Diabe!e#

T+(e 'iabe!e#

K-e&& 'e#!r!i%n

T+(e 7 'iabe!e#

Pr%gre##i"e in#&in #ere!%r+ 'e)e!

O!*er #(ei !+(e# %) 'iabe!e#

Gene!i 'e)e!# in K-e&& )n!i%n, in#&in a!i%n

Di#ea#e# %) !*e e%rine (anrea# 5+#!i

br%#i#, (anrea!i!i#6 Drg- %r *e$ia&-in'e' 5!rea!$en! %) AIDS %r

a)!er %rgan !ran#(&an!a!i%n6

Ge#!a!i%na& 'iabe!e# $e&&i!#$D$% &% 'lassification and Diagnosis% Diabetes Care2(11*+)!suppl 1#.12%


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8+(%!*e!ia& S!age# in !*e De"e&%($en! %)T+(e Diabe!e# 5Fr%$ Gene!i S#e(!ibi&i!+

!% -e&& De#!r!i%n6

PrecipitatingAgent

Age (years)

Beta

cell

mass

Genetic

predisposition

Overt

immnologica!normalities

N insulinrelease

Progressiveloss inslinrelease

GlucoseNormal

OvertDia!etes

C-peptide

present

No C-peptide

Type 1 diabetes occurs individuals in whom genetic susceptibility outweighs genetic protection

GDM 'iagn%#!i !*re#*%&' "a&e# )r%$


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GDM 'iagn%#!i !*re#*%&' "a&e# )r%$"ari%# %rgania!i%n

-*%r

P&a#$a g&%#e %nen!ra!i%n!*re#*%&'# 5$g:'&6

Organia!i%n OGTTg&%#e

&%a'

Fa#!ing

ADA/Carpenter G

Coustan2

Documents

Classification and Diagnosis of Dm Isd Workshop 2014