Sunday, September 9, 2007

Diabetes - Diagnostic criteria

Diagnostic criteria
Diabetes mellitus is characterized by recurrent or persistent hyperglycemia, and is diagnosed by demonstrating any one of the following:[1]

fasting plasma glucose level at or above 126 mg/dL (7.0 mmol/l).
plasma glucose at or above 200 mg/dL or 11.1 mmol/l two hours after a 75 g oral glucose load as in a glucose tolerance test.
random plasma glucose at or above 200 mg/dL or 11.1 mmol/l.
A positive result should be confirmed by another of the above-listed methods on a different day, unless there is no doubt as to the presence of significantly-elevated glucose levels. Most physicians prefer measuring a fasting glucose level because of the ease of measurement and the considerable time commitment of formal glucose tolerance testing, which can take two hours to complete. By current definition, two fasting glucose measurements above 126 mg/dL or 7.0 mmol/l is considered diagnostic for diabetes mellitus.

Patients with fasting sugars between 6.1 and 7.0 mmol/l (ie, 110 and 125 mg/dL) are considered to have "impaired fasting glycemia" and patients with plasma glucose at or above 140mg/dL or 7.8 mmol/l two hours after a 75 g oral glucose load are considered to have "impaired glucose tolerance". "Prediabetes" is either impaired fasting glucose or impaired glucose tolerance; the latter in particular is a major risk factor for progression to full-blown diabetes mellitus as well as cardiovascular disease.

While not used for diagnosis, an elevated level of glucose irreversibly bound to hemoglobin (termed glycosylated hemoglobin or HbA1c) of 6.0% or higher (the 2003 revised U.S. standard) is considered abnormal by most labs; HbA1c is primarily used as a treatment-tracking test reflecting average blood glucose levels over the preceding 90 days (approximately). However, some physicians may order this test at the time of diagnosis to track changes over time. The current recommended goal for HbA1c in patients with diabetes is <7.0%, which as defined as "good glycemic control", although some guidelines are stricter (<6.5%). People with diabetes who have HbA1c levels within this range have a significantly lower incidence of complications from diabetes, including retinopathy and diabetic nephropathy