Diabetes Mellitus: Screening and Diagnosis

 


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Am Fam Physician. 2016 Jan 15;93(2):103-109.

  Related U.S. Preventive Services Task Force recommendation statement: Screening for Abnormal Blood Glucose and Type 2 Diabetes Mellitus: Recommendation Statement

Author disclosure: No relevant financial affiliations.

Diabetes mellitus is one of the most common diagnoses made by family physicians. Uncontrolled diabetes can lead to blindness, limb amputation, kidney failure, and vascular and heart disease. Screening patients before signs and symptoms develop leads to earlier diagnosis and treatment, but may not reduce rates of end-organ damage. Randomized trials show that screening for type 2 diabetes does not reduce mortality after 10 years, although some data suggest mortality benefits after 23 to 30 years. Lifestyle and pharmacologic interventions decrease progression to diabetes in patients with impaired fasting glucose or impaired glucose tolerance. Screening for type 1 diabetes is not recommended. The U.S. Preventive Services Task Force recommends screening for abnormal blood glucose and type 2 diabetes in adults 40 to 70 years of age who are overweight or obese, and repeating testing every three years if results are normal. Individuals at higher risk should be considered for earlier and more frequent screening. The American Diabetes Association recommends screening for type 2 diabetes annually in patients 45 years and older, or in patients younger than 45 years with major risk factors. The diagnosis can be made with a fasting plasma glucose level of 126 mg per dL or greater; an A1C level of 6.5% or greater; a random plasma glucose level of 200 mg per dL or greater; or a 75-g two-hour oral glucose tolerance test with a plasma glucose level of 200 mg per dL or greater. Results should be confirmed with repeat testing on a subsequent day; however, a single random plasma glucose level of 200 mg per dL or greater with typical signs and symptoms of hyperglycemia likely indicates diabetes. Additional testing to determine the etiology of diabetes is not routinely recommended.

Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both.1,2 Uncontrolled diabetes can lead to blindness, limb amputation, kidney failure, vascular disease, and heart disease. It is estimated that in the next 20 years, the number of persons with type 2 diabetes in the United States will reach 44 million, approximately double the current prevalence.3 Diabetes likely will continue to be one of the most common diagnoses made by family physicians.4 Diagnostic testing should be performed in individuals with a clinical history indicative of diabetes. Symptoms that should prompt consideration of diabetes include polyuria, polydipsia, fatigue, blurry vision, weight loss, poor wound healing, numbness, and tingling. This article focuses on screening and diagnosis of diabetes in asymptomatic patients.

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Treatment of impaired fasting glucose and impaired glucose tolerance with pharmacologic interventions, lifestyle interventions, or both decreases progression to diabetes mellitus.

C

7, 8

Patients 40 to 70 years of age who are overweight or obese should be screened for type 2 diabetes. Persons with abnormal results should be referred for intensive behavioral counseling interventions that focus on physical activity and a healthy diet.

B

7, 8

If initial screening results for type 2 diabetes are normal, screening may be repeated every three years.

C

7, 8

Diagnosis of type 2 diabetes can be made using fasting plasma glucose, A1C testing, random plasma glucose testing, or an oral glucose tolerance test.

C

1, 2


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Treatment of impaired fasting glucose and impaired glucose tolerance with pharmacologic interventions, lifestyle interventions, or both decreases progression to diabetes mellitus.

C

7, 8

Patients 40 to 70 years of age who are overweight or obese should be screened for type 2 diabetes. Persons with abnormal results should be referred for intensive behavioral counseling interventions that focus on physical activity and a healthy diet.

B

7, 8

If initial screening results for type 2 diabetes are normal, screening may be repeated every three years.

C

7, 8

Diagnosis of type 2 diabetes can be made using fasting plasma glucose, A1C testing, random plasma glucose testing, or an oral glucose tolerance test.

C

1, 2


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

Classifying Diabetes

The Authors

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KARLY PIPPITT, MD, is an assistant professor and director of medical student education in family medicine at the University of Utah School of Medicine, Salt Lake City, Utah....

MARLANA LI, MD, is an assistant professor and also serves as the assistant clerkship director for the family medicine rotation at the University of Utah School of Medicine.

HOLLY E. GURGLE, PharmD, is an assistant professor at the University of Utah College of Pharmacy. Her clinical practice site is the ARUP Family Health Clinic in Salt Lake City.

Author disclosure: No relevant financial affiliations.

Address correspondence to Karly Pippitt, MD, University of Utah School of Medicine, 375 Chipeta Way, Ste. A, Salt Lake City, UT 84108 (e-mail: Karly.pippitt@hsc.utah.edu). Reprints are not available from the authors.

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