american association diabetes educators

Recommended Approach to Dx of DM in HK
Symptomatic pt:FPG or RPG on 2 occasions.Epidemiological survey:FPG or 2hrPG after OGTT.DM screening:No risk factors: FPG.Risk factor +ve: OGTT or (FPG + HbA1c).OGTT if:Hx of IGTKnown IFGFPG>5.6mmol/l and HbA1c>5.5%
Risk Factors for DM
Consider Screening for glucose intolerance and other CVS risk factors:
Age >45.Overweight (BMI >23kg/m2).HT.Dyslipidemia (esp high TG).Hx of gestational diabetes.FH (1st degree relatives) of DM.
Dx Criteria of DM
DM: FPG >7.0 or RPG >11.1 or 2hPG >11.1IGT: FPG <7.0 2hpg="7.8-<11.1IFG:" fpg =" 6.1-<7.0NFG:" l =" 100mg/dl6.1mmol/l" l =" 126mg/dl7.8mmol/l" l =" 200mg/dl">300mg/dOvernight urine:Normal: <20mcg/minmicro:>200mcg/minEMU or spot urine albumin:Normal: <20mg/lmicro:>200mg/lEMU or spot urine Alb:Cr ratio (ACR):Normal: M<2.5,>38mg/mmol
Notes:
If 1st test +ve, repeat 1-2 more times: 2/3 +ve results before diagnosing microalbuminuria. Spot urine ACR is simple and can be used as screening test.
Treatment Target Values
Ideal value shown here.US = unsatisfactoryAdjust Tx goals acc. to age, risk factors and co-existing complications.
FPG = 4-6mmol/l [US if >8]HbA1c <1.1x>1.3]BMI <23>27]Waist circumferenceM <75cm>90cm (>36")]F <70cm>80cm (>32")]SBP <135mmhg>160]DBP <85mmhg>95]Total CE <4.5mmol/l>6.2]HDL-CE >1.1mmol/l [US <0.9]ldl-ce>4.2]TG <1.5mmol/l>2.8]
Definition of Obesity
[Using BMI = BW (kg) / Height (m)2]
WHOOverweight: BMI = 25-<30obesity:>30National Diabetes Data GroupObesity: BMI >25 (F) or >27 (M)International Obesity Task Force (for Asians)Overweight: BMI >23At-risk: BMI = 23-<25obese bmi =" 25-<30Obese">30
Etiological Classification of Diabetes
Type 1 diabetes mellitus(absolute insulin deficiency)AutoimmuneIdiopathicType 2 diabetes mellitus(range from insulin resistant with relative insulin deficiency to predominately secretory type with or without insulin resistance).Other specific types:Genetic defects of B-cell functionMODY type 1-5Mitochondrial DNA mutationOthersGenetic defects in insulin actionType A insulin resistanceLeprechaunismRabson-Mendenhall synLipoatrophic diabetesOthersDiseases of exocrine pancreasPancreatitisHaemochromatosisOthersEndocrinopathiesAcromegalyCushing's synOthersDrug or chemical-induced (eg. thiazides, steroids).Infections (eg. congenital Rubella).Uncommon forms of immune- mediated diabetes (eg. 'stiff man' syn).Other genetic syndromes sometimes associated with diabetes:Down's synFriedreich's ataxiaHuntington's choreaKlinefelter's synLawrence-Moon-Biedel synMyotonic dystrophyPorphyriaPrader-Willi synTurner's synWolfram's synOthersGestation diabetes(Include fomer categories of gestational IGT and gestational DM).