Diagnostic criteria  for impair glucose metabolism
Diagnostic criteria for impair glucose metabolism Criteria    ADA   WHO Normoglycemia  FPG< 100  mg/dl FPG< 110  mg/dl   2...
Risk factors for type II DM <ul><li>Age  ≥  45   years </li></ul><ul><li>Over weight (BMI >  25  kg/m 2 ) </li></ul><ul><l...
Impaired fasting glucose and impaired glucose tolerance <ul><li>Form an intermediate stage in the natural history  of DM <...
Hemoglobin A1c <ul><li>A subset of glycated Hb, accumulate in RBC in  </li></ul><ul><li>proportion to blood glucose level ...
Correlation between mean blood glucose and HbA1c There is a linear relationship between HbA1c and  mean plasma glucose (MP...
Glycemic goal for adult with DM Glycemic parameter   ACE    ADA HbA1c   ≤  6.5%   <  7% FPG   <  110  mg/dl   90-130  mg/d...
Application of IFG and HbA1c for diagnosis of IGT/DM <ul><li>NIH study estimate the rate of progression from IFG to DM in:...
HgbA1c <ul><li>505  subjects screened for type  2   diabetes </li></ul><ul><li>Only  4 % identified by fasting blood </li>...
EPIC-Norfolk all cause mortality relative risk  AIC   5-5.4%  5.5-5.9 %  6-6.4 %   6.5-6.9 % >6.9 % Men  RR  1.25   1.57  ...
HbA1c as a CV Risk Factor <ul><li>“ In men and women A1c concentrations predicted coronary heart, </li></ul><ul><li>cardio...
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Hb A1c

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Hb A1c

  1. 1. Diagnostic criteria for impair glucose metabolism
  2. 2. Diagnostic criteria for impair glucose metabolism Criteria ADA WHO Normoglycemia FPG< 100 mg/dl FPG< 110 mg/dl 2h PG< 140 mg/dl 2 hPG< 140 mg/dl IFG FPG≥ 100 and < 126 mg/dl FPG ≥ 110 and < 126 mg/dl IGT 2h PG ≥ 140 and < 200 mg/dl 2h PG ≥ 140 and < 200 mg/dl Diabetes FPG ≥ 126 mg/dl FPG ≥ 126 mg/dl 2h PG ≥ 200 mg/dl 2h PG ≥ 200 mg/dl Symtoms of DM and casual PG ≥ 200 mg/dl Note: To convert from the conventional unit to SI unit multiply by 0.0555
  3. 3. Risk factors for type II DM <ul><li>Age ≥ 45 years </li></ul><ul><li>Over weight (BMI > 25 kg/m 2 ) </li></ul><ul><li>Family history of DM </li></ul><ul><li>Physical inactivity </li></ul><ul><li>Previously identify IFG or IGT </li></ul><ul><li>History of GDM or delivery of a baby weight > 4 kg </li></ul><ul><li>Hypertension </li></ul><ul><li>HDL-Cholesterol ≤ 35 mg/dl ( 0.90 mmol/l) </li></ul><ul><li>and/or TG ≥ 250 mg/dl ( 2.82 mmol/l ) </li></ul><ul><li>PCOS </li></ul><ul><li>History of vascular disease: CAD, ischemic stroke </li></ul>
  4. 4. Impaired fasting glucose and impaired glucose tolerance <ul><li>Form an intermediate stage in the natural history of DM </li></ul><ul><li>Incidence: 10-15 % of population </li></ul><ul><li>The first glucose abnormality is a rise in the postprandial </li></ul><ul><li>glucose (IGT). With time, further decline in beta-cell </li></ul><ul><li>function leads to IFG </li></ul><ul><li>Postprandial glucose has higher sensitivity for predicting </li></ul><ul><li>progression to DM than IFG and more strongly </li></ul><ul><li>associated with CVD outcome </li></ul>
  5. 5. Hemoglobin A1c <ul><li>A subset of glycated Hb, accumulate in RBC in </li></ul><ul><li>proportion to blood glucose level </li></ul><ul><li>Provide an overall measure of a patient’s plasma glucose </li></ul><ul><li>during the previous 2-3 months </li></ul><ul><li>Represents the effect of fasting and postprandial </li></ul><ul><li>glucose level </li></ul><ul><li>It is the gold standard for assessing glycemic control in </li></ul><ul><li>patients with DM since it is an important marker </li></ul><ul><li>for micro and macrovascular complication </li></ul>
  6. 6. Correlation between mean blood glucose and HbA1c There is a linear relationship between HbA1c and mean plasma glucose (MPG) HbA1c (%) MPG (mg/dl) 6 120 7 150 8 180 9 210 10 240 11 270 Formular: MPG= (33.3 x HbA1c)-86
  7. 7. Glycemic goal for adult with DM Glycemic parameter ACE ADA HbA1c ≤ 6.5% < 7% FPG < 110 mg/dl 90-130 mg/dl postprandial glucose < 140 mg/dl < 180 In non-diabetes , increase HbA1c is associated with a significant increase risk of cardiovascular and cerebrovascular disease with hazard ratio of 1.13-1.7 at HbA1c ≥ 5.7%
  8. 8. Application of IFG and HbA1c for diagnosis of IGT/DM <ul><li>NIH study estimate the rate of progression from IFG to DM in: </li></ul><ul><ul><ul><li>New IFG criteria ( 100-109 mg/dl)= 1.34%/ yr </li></ul></ul></ul><ul><ul><ul><li>Old IFG criteria ( 110-125 mg/dl)= 5.56%/ yr </li></ul></ul></ul><ul><li>Predictor of hyperglycemia progression </li></ul><ul><ul><ul><li>younger age </li></ul></ul></ul><ul><ul><ul><li>Female </li></ul></ul></ul><ul><ul><ul><li>high BMI </li></ul></ul></ul><ul><ul><ul><li>low HDL and high TG </li></ul></ul></ul><ul><ul><ul><li>high systolic BP </li></ul></ul></ul><ul><li>A combination of FPG ≥ 102 mg/dl and HbA1c ≥ 5.7 is highly </li></ul><ul><li>predictive of IGT (Sensitivity, specificity 85%) </li></ul><ul><li>HbA1c ≥ 7% : Sensitivity > 90% for DM </li></ul>
  9. 9. HgbA1c <ul><li>505 subjects screened for type 2 diabetes </li></ul><ul><li>Only 4 % identified by fasting blood </li></ul><ul><li>glucose as opposed to 10.4% by OGTT </li></ul><ul><li>HgbA1c >= 6.2% had 100% correlation with </li></ul><ul><li>OGTT diagnosis </li></ul><ul><li>Cardiovascular risk in increased 1.8-2.2 times at HgbA1c </li></ul><ul><li>of 5.6-6.1%; increased 2 times at >= 6.2% </li></ul><ul><li>Diabetes Care 2003,26(2): 485-90 </li></ul><ul><li>AIMA-VI (Dr.Richard Brown, </li></ul><ul><li>Quest diagnostic, USA) </li></ul>
  10. 10. EPIC-Norfolk all cause mortality relative risk AIC 5-5.4% 5.5-5.9 % 6-6.4 % 6.5-6.9 % >6.9 % Men RR 1.25 1.57 1.8 3.49 3.38 Death Women RR 1.02 1.28 1.61 1.71 6.91 Death
  11. 11. HbA1c as a CV Risk Factor <ul><li>“ In men and women A1c concentrations predicted coronary heart, </li></ul><ul><li>cardiovascular disease, and total mortality… independent of </li></ul><ul><li>and only slightly attenuated after adjustment for known </li></ul><ul><li>risk factors.” </li></ul><ul><li>“ an increase of A1c of 1 percentage point was associated with a </li></ul><ul><li>20-30% increase in event rates.” </li></ul><ul><li>“… glycosylated hemoglobin can now be added to the list of </li></ul><ul><li>other clearly established indicators of cardiovascular risk..” </li></ul><ul><li>“ Thus, the presence or absence of diabetes is likely to become less </li></ul><ul><li>important than the level of glycosylated hemoglobin in </li></ul><ul><li>the assessment of CV risk…” </li></ul>

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