Diabetes Testing and Metabolic Syndrome Criteria Indications for Testing All people over 35 pts <35 of age who: overweight or obese 1st degree relative with diabetes high race or ethnicity risk Physical inactivity dyslipidemia CVD other conditions associated with insulin resistance (PCOS, polycystic ovary syndrome) Prediabetes or risk of gestational diabetes Have any risk enhancing comorbidities including: HIV infection Pancreatic disease Post organ transplantation Consider screening all pts when determining diabetes risk factors, even when no risk factors are present Individuals who are planning pregnancy with any risk factor for T2DM (e.g., obesity, insulin resistance) RBG ≥ 200 mg/dL in pts with hypoglycemia symptoms or hypoglycemic crisis ≥2 abnormal results for asymptomatic pts Fasting Plasma Glucose: measured after 8 hrs of fasting * normal: <100 mg/dL (5.6 mmol/L) * prediabetes: 100-125 mg/dL (5.6-6.9 mmol/L) * diabetes: ≥126 mg/dL (7.0 mmol/L) Oral Glucose Tolerance Test: measurement of fasting plasma glucose by blood glucose 2 hrs after the consumption of 75g of glucose * normal: <140 mg/dL (7.8 mmol/L) * prediabetes: 140-199 mg/dL (7.8-11.1 mmol/L) * diabetes: ≥200 mg/dL (11.1 mmol/L) norm C5.7% pre-diabeles S7-6.4% OM 765% Dubetes mellitus screwing Nong Patent year Pemogico ATG 07-64% FFO 2125 Ng OCT200 male DOT7 140-190GT140 Beg power glucoen Daterse mellius Pradubetes Healthy Da millius Prediabetus Important Facks abad WAL • Can be measured at any time • Results may be altered by a variety of conditions or treatments, e.g.. sickle cell trait, chronic kidney disease. [10][25][26] Factors resulting in a falsely high HbA1c • Increased RBC lifespan: e.g., iron and/or vitamin B12 deficiency. splenectomy, aplastic anemia • Altered hemoglobin: chronic kidney disease • Factors resulting in a falsely low HbA1c • Decreased RBC lifespan: e.g., due to acute blood loss. hemoglobinopathies such as sickle cell trait/disease, thalassemia. G6PD-deficiency, cirrhosis, hemolytic anemia, splenomegaly, antiretroviral drugs Increased erythropoiesis. e.g., due to EPO therapy. reticulocytosis, pregnancy (second and third trimesters), iron supplementation Altered hemoglobin: high-dose vitamin C and E supplementation BMP •low GFR suggestive of CKD clearly sign of diabehc nephropally → electrolytes exp. k+ Spot Urinary albumin: Gr delecion of miro albumeva level correlates with risk of cardiovascula renal complications C-peptide → insulin resistance & hyperinsulinemia - T2DM → insulin deficiency - T1DM Urinalysis → glucosuria non-specific → ketone bodies ↑ in acute metabolic decompensation → microalbuminuria - early signs of diabetic nephropathy Islet Autoantibody testing - consider in pt diagnosed with DM where T1DM Anti-GAD Abs Anti-tyrosine phosphate-related islet antigen-2 (CIA-2) Anti-Zn transporter & Abs Metabolic Syndrome Criteria