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New Guidelines Issued for Diagnosing Diabetes:diabetesmonitor.com:"Levels of blood sugar that have long been accepted as normal are actually too high and should be considered a sign of diabetes, according to new guidelines issued Monday by the American Diabetes Association and endorsed by federal health authorities. The guidelines call for testing all healthy people age 45 and older -- about 77 million Americans -- every three years, and are expected to lead to the detection of 2 million new cases. Under the guidelines, testing would start earlier and be done more often in people with higher risk, including those who are obese, black, Hispanic, American Indian or closely related to someone with diabetes. The new guidelines, announced at a medical conference in Boston, have been endorsed by the Centers for Disease Control and Prevention and the National Institute of Diabetes and Digestive and Kidney Diseases. A report on the recommendations will be published in the July issue of the journal Diabetes Care. Doctors usually follow the association's recommendations." http://www.diabetesmonitor.com/dx-class.htm What are the new diagnostic criteria for patients with diabetes?:eMJA:"Clinicians should note that the diagnostic criteria differ between clinical and epidemiological settings. In clinical practice, when symptoms are typical of diabetes, a single fasting plasma glucose level of 7.0 mmol/L or 2 h post-glucose or casual postprandial plasma glucose level of 11.1 mmol/L suffices for diagnosis. If there are no symptoms, or symptoms are equivocal, at least one additional glucose measurement (preferably fasting) on a different day with a value in the diabetic range is necessary to confirm the diagnosis. Furthermore, severe hyperglycemia detected under conditions of acute infective, traumatic, circulatory or other stress may be transitory and should not be regarded as diagnostic of diabetes. The situation should be reviewed when the primary condition has stabilised" http://www.mja.com.au/public/issues/apr19/colman/colman.html Diagnosis and Classification of Diabetes - What's New?:georgetown.edu:"In order to make a diagnosis of Type 1 or Type 2 diabetes, the fasting plasma glucose (blood sugar) has to be greater than 125 mg/dl. You may remember that diabetes used to be diagnosed when fasting plasma glucose was over 140 mg/dl. People with a single fasting test over125 mg/dl should have a second fasting test to confirm the diagnosis. The commitee recommends no longer using the oral glucose tolerance test since it is difficuclt and expensive. It is important that people find out that they have diabetes sooner since we know that about one quarter of people with Type 2 diabetes already have some evidence of complications when they are diagnosed by the old criteria. In addition, many studies indicate that the risk of these complications could have been reduced if the person had been treated resulting in control of blood glucose." http://www.georgetown.edu/departments/pediatrics/diabetes/diagnosisclassification.html What criteria have changed in the diagnosis of diabetes?:American Family Physician:"In 1979, the National Diabetes Data Group produced a consensus document standardizing the nomenclature and definitions for diabetes mellitus.[3] This document was endorsed one year later by WHO.[4,5] The two major types of diabetes mellitus were given names descriptive of their clinical presentation: "insulin-dependent diabetes mellitus" (IDDM) and "non-insulin-dependent diabetes mellitus" (NIDDM). However, as treatment recommendations evolved, correct classification of the type of diabetes mellitus became confusing. For example, it was difficult to correctly classify persons with NIDDM who were being treated with insulin. This confusion led to the incorrect classification of a large number of patients with diabetes mellitus, complicating epidemiologic evaluation and clinical management. The discovery of other types of diabetes with specific pathophysiology that did not fit into this classification system further complicated the situation. These difficulties, along with new insights into the mechanisms of diabetes mellitus, provided a major impetus for the development of a new classification system" http://www.findarticles.com/m3225/n6_v58/21251945/p1/article.jhtml People at Risk for Type 2 Diabetes- diagnosis:thejcdp.com:"Type 2 diabetes is nearing epidemic proportions due to an increased number of older Americans and a greater prevalence of obesity and a sedentary lifestyle. The underlying problem is insulin resistance, with some degree of insulin deficiency. Often type 2 diabetes can be controlled through weight loss, improved nutrition, and exercise alone. Sometimes these are not enough and either oral medications and/or insulin must be used. People usually develop type 2 after age 45, but often are not aware they have diabetes until severe symptoms occur or they are treated for one of its serious complications. The risk for type 2 increases with age. Nearly 18.4% of the United States population aged 65 or older has type 2 diabetes. Table 1 summarizes the risk for type 2 diabetes. " http://www.thejcdp.com/issue002/varon/04var.htm DIAGNOSTIC CRITERIA FOR DIABETES MELLITUS:diabetesjournals.org:"The revised criteria are still based on measures of hyperglycemia. Whereas many different diagnostic schemes have been used all have been based on some measurement of blood or urine glucose, as reviewed by McCance et al. (125). The metabolic defects underlying hyperglycemia, such as islet cell autoimmunity or insulin resistance, should be referred to independently from the diagnosis of diabetes, i.e., in the classification of the disease. Determining the optimal diagnostic level of hyperglycemia depends on a balance between the medical, social, and economic costs of making a diagnosis in someone who is not truly at substantial risk of the adverse effects of diabetes and those of failing to diagnose someone who is (126). Unfortunately, not all these data are available, so we relied primarily on medical data." http://care.diabetesjournals.org/cgi/content/full/25/suppl_1/s5 A Lower Number To Diagnose Diabetes :National Diabetes Information Clearinghouse:"The expert committee also recommended a lower fasting plasma glucose (FPG) value to diagnose diabetes. The new FPG value is 126 milligrams per deciliter (mg/dL) or greater, rather than 140 mg/dL or greater. This recommendation was based on a review of the results of more than 15 years of research. This research showed that a fasting blood glucose of 126 mg/dL or greater is associated with an increased risk of diabetes complications affecting the eyes, nerves, and kidneys. When diagnosis was based on a blood glucose value of 140 mg/dL or greater, these complications often developed before the diagnosis of diabetes. The experts believe that earlier diagnosis and treatment can prevent or delay the costly and burdensome complications of diabetes." http://www.niddk.nih.gov/health/diabetes/pubs/diagnosis/diagnosis.htm The two primary tests and their results which combine to make the diagnosis of diabetes :endocrineweb.com:"In diagnosing diabetes, physicians primarily depend upon the results of specific glucose tests. However, test results are just part of the information that goes into the diagnosis of diabetes. Doctors also take into account your physical exam, presence or absence of symptoms, and medical history. Some people who are significantly ill will have transient problems with elevated blood sugars which will then return to normal after the illness has resolved. Also, some medications may alter your blood glucose levels (most commonly steroids and certain diuretics (water pills)). The two main tests used to measure the presence of blood sugar problems are [1] the direct measurement of glucose levels in the blood during an overnight fast, and [2] measurement of the body's ability to appropriately handle the excess sugar presented after drinking a high glucose drink" http://www.endocrineweb.com/diabetes/diagnosis.html The requirements for diagnostic confirmation of diabetes:staff.ncl.ac.uk:"If a diagnosis of diabetes is made, the clinician must feel confident that the diagnosis is fully established since the consequences for the individual are considerable and lifelong. The requirements for diagnostic confirmation for a person presenting with severe symptoms and gross hyperglycaemia differ from those for the asymptomatic person with blood glucose values found to be just above the diagnostic cut-off value. Severe hyperglycaemia detected under conditions of acute infective, traumatic, circulatory or other stress may be transitory and should not in itself be regarded as diagnostic of diabetes. The diagnosis of diabetes in an asymptomatic subject should never be made on the basis of a single abnormal blood glucose value. For the asymptomatic person, at least one additional plasma/blood glucose test result with a value in the diabetic range is essential, either fasting, from a random (casual) sample, or from the oral glucose tolerance test (OGTT)" http://www.staff.ncl.ac.uk/philip.home/who_dmc.htm Diabetes Basics - Diagnosis:lifeclinic.com:"The only way you can be sure you have diabetes is by getting a test. The American Diabetes Association (ADA) now recommends that everyone over age 45 should have a fasting plasma glucose test. If test results are normal, the test should be repeated every three years. If you have risk factors for diabetes, you should be tested at a younger age and more often. The high risk factors include: Being more than 20 percent above your ideal body weight or having a body mass index (BMI) of greater than or equal to 27. The BMI is the ratio of weight in kilograms to height in meters squared. Your doctor can give you information on your BMI..." http://www.lifeclinic.com/focus/diabetes/diagnosis.asp Search Nursing Diabetics http://www.nursingdiabetics.com/A-Z_list/ ******************************************************
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