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We have already published on our website a summary of all changes in the diagnosis and management of diabetes, in accordance with the new guidelines of the American Diabetes Association. Our challenge now is to delve deeper into each topic by providing a summary of the most relevant points of the publication. In this article, we will discuss changes in the clbadification and diagnosis of diabetes.
- Type 1 diabetes mellitus (due to autoimmune destruction of β cells, generally leading to an absolute deficiency of insulin)
- Type 2 diabetes mellitus (due to autoimmune destruction of β-cells, generally leading to an absolute deficiency of insulin) progressive loss of insulin secretion of β cells frequently in the context of insulin resistance)
- Diabetes mellitus of diabetes (diagnosed diabetes in the second or third trimester pregnancy that was not clearly diabetes before pregnancy) [19659004] Specific types of diabetes due to other causes, eg, monogenic diabetic syndromes (such as neonatal diabetes and juvenile diabetes [MODY]), exocrine pancreatic diseases (such as cystic fibrosis and pancreatitis) and drugs or diabetes of chemical origin (such as the use of glucocorticoids)
Criteria of Diagnosis:
Diabetes can be diagnosed on the basis of: glucose criteria, fasting blood glucose or 2-hr plasma glucose in an oral glucose test at 75 g (TOTG), or glycated hemoglobin (A1C).
| Diagnostic Criteria for Diabetes ADA. 2019 | |||||||
| Fasting blood glucose level * ≥ 126 mg / dL | |||||||
| Or | |||||||
| Plasma plasma glucose concentration after 2 hours of TOTG ** ≥ 200 mg / dL | |||||||
| Or | |||||||
| A1C ≥6.5% | |||||||
| Gold | |||||||
| In the absence of unequivocal hyperglycemia, the diagnosis requires two results | |||||||
| of abnormal tests of the same sample. | |||||||
| If the patient exhibits clbadic symptoms of hyperglycemia or hyperglycemic crisis, | |||||||
| a random plasma glucose level ≥200 mg / or in two separate samples |
Note: * Fasting is defined as an absence of caloric intake for at least 8 hours
. ** The test should be performed as described by the WHO using a glucose load containing the equivalent of 75 g of anhydrous glucose dissolved in water.
*** The A1C test should be performed using a method consisting of:
The text emphasizes that the A1C test has several advantages over the fasting glucose and TOTG, including increased convenience (fasting not required), superior pre-badytic stability, and reduced daily disturbance. during stress and illness. However, these benefits may be offset by lower A1C threshold sensitivity, higher cost, limited availability of A1C tests in some areas of the developing world, and imperfect correlation between A1C and average glucose in some individuals.
When A1C is used to diagnose diabetes, it is important to recognize that it is an indirect measure of average blood glucose and to consider other factors affecting blood glucose levels. hemoglobin regardless of blood glucose, including HIV treatment, age, race / ethnicity, pregnancy, genetic history and anemia / hemoglobinopathies.
The big difference from this guideline is to bring the ability to diagnose diabetes with the help of a single blood sample. The authors advise the following:
" Unless there is a clear clinical diagnosis (eg patient in hyperglycaemic crisis or with clbadic symptoms of hyperglycemia and random plasma glucose ≥ 200 mg / dL) , the diagnosis requires two abnormal results from the same sample or two separate test samples.If you use two separate test samples, it is recommended that the second test, which may be a repeat of the initial test or a different test, be performed without delay. "
You are a doctor and you also want to be a portal chronicler of PEBMED? Dayanna de Oliveira Quintanilha "clbad =" avatar avatar-100 wp-user-avatar wp-user-avatar-100 photo alignnone "/>
Doctor at the Naval Hospital Marcílio Dias ⦁ Residence in Clinical Medicine at l & # UFF ⦁ Degree in Medicine from the University of São Paulo UFF ⦁ Contact: [email protected]
