Type 2 diabetes – diagnosis
Tests – criteria to establish Type 2 diabetes Fasting plasma glucose of > 7.0 mmol / L or more Fasting is defined as no caloric intake for atleast 8 hrs
Random Blood glucose > 11.1 mmol /L , And presence of symptoms of diabetes including polyuria , polydipsia and unexplained weight loss
If the person is symptomatic – a single HbA1c or fasting plasma glucose level can be used , although repeat testing is sensible to confirm diagnosis
If the person is asymptomatic – do not diagnose diabetes on the basis of a single abnormal HbA1c or plasma glucose result Repeat the test preferably the same one to confirm diagnosis ( if repeat test normal -monitor )
HbA1c of 48 mmol /mol ie 6.5 % or more HbA1c may lack accuracy ( specificity / and or sensitivity ) in the following group age < 18 yrs acute – onset glycemic states such as post-traumatic type 2 diabetes ( e,g pancreatitis ) rapid onset of glycemia with sepsis and steroid use ie severe glycemia when a person is acutely unwell is not diagnostic of diabetes on long term medications which can cause hyperglycemia as steroids pregnant women or 2 months post partum people with underlying haemoglobinopathy or hemolysis or advanced CKD , sickle cell disease , recent blood transfusion , iron deficiency anaemia pancreatic damage including pancreatic surgery End stage renal disease ( ESRD ) HIV infection
Take into account any existing disease suggesting insulin resistance as CVD Obesity PCOS NAFLD Metabolic syndrome
OGTT 11.1 mmol / L or more – as per WHO instructions 8 hr fasting 75 g glucose oral venous blood fasting and 2 hr post glucose challenge.
REFERENCES
- Type 2 diabetes what is it ? CKS NHS Definition | Background information | Diabetes – type 2 | CKS | NICE
- Freeman AM, Pennings N. Insulin Resistance. 2021 Jul 10. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 29939616. ( Excerpt ) Insulin Resistance – PubMed (nih.gov)
- Irish College of General Practitioners A practical guide to Integrated Type 2 Diabetes Care Dr Velma Harkins icgp-guide-to-integrated-type-2.pdf (hse.ie)
