2. DIABETES
Diabetes-
its a chronic medical condition
characterized by elevated levels of
blood sugar (glucose) in the body.
This occurs either because the
pancreas does not produce enough
insulin (a hormone that helps
regulate blood sugar) or because
the body's cells do not respond
adequately to the insulin that is
produced.
4. • Type 1 Diabetes
• Type 2 Diabetes
• Gestational Diabetes
• Monogenic Diabetes Syndromes
• Cystic Fibrosis-Related Diabetes
• Post transplantation Diabetes Mellitus
American Diabetes Association Standards of Medical Care in Diabetes.
Classification and diagnosis of diabetes. Diabetes Care 2018; 40 (Suppl. 1): S13-S22
5. Type 1 diabetes [β-cell destruction]
Type 2 diabetes [Progressive insulin secretory defect on the
background of insulin resistance]
Gestational Diabetes Mellitus (GDM)
Other specific types of diabetes due to other causes:
Monogenic diabetes syndromes
Diseases of the exocrine pancreas, e.g., cystic fibrosis
Drug- or chemical-induced diabetes
American Diabetes Association Standards of Medical Care in Diabetes.
Classification and diagnosis of diabetes. Diabetes Care 2018; 40 (Suppl. 1): S13-S22
6. CRITERIA FOR THE DIAGNOSIS
OF DIABETES
American Diabetes Association Standards of Medical Care in Diabetes.
Classification and diagnosis of diabetes. Diabetes Care 2018; 40 (Suppl. 1): S13-S22
7. CATEGORIES OF INCREASED RISK FOR
DIABETES (PREDIABETES)
American Diabetes Association Standards of Medical Care in Diabetes.
Classification and diagnosis of diabetes. Diabetes Care 2018; 40 (Suppl. 1): S13-S22
8. • Screening for prediabetes and risk for future diabetes
with an informal assessment of risk factors or validated
tools should be considered in asymptomatic adults.
PREDIABETES
American Diabetes Association Standards of Medical Care in Diabetes.
Classification and diagnosis of diabetes. Diabetes Care 2018; 40 (Suppl. 1): S13-S22
9. • Testing for prediabetes and risk for future diabetes in
asymptomatic people should be considered in adults of
any age who are overweight or obese (BMI ≥25 kg/m2 or
≥23 kg/m2 in Asian Americans) and who have one or
more risk factors for diabetes
• For all people, testing should begin at age 45 years.
PREDIABETES
American Diabetes Association Standards of Medical Care in Diabetes.
Classification and diagnosis of diabetes. Diabetes Care 2018; 40 (Suppl. 1): S13-S22
10. TESTING FOR DIABETES OR PREDIABETES IN
ASYMPTOMATIC ADULTS
American Diabetes Association Standards of Medical Care in Diabetes.
Classification and diagnosis of diabetes. Diabetes Care 2018; 40 (Suppl. 1): S13-S22
11. • If tests are normal, repeat testing carried out at a
minimum of 3-year intervals is reasonable.
• To test for prediabetes, fasting plasma glucose, 2-h
plasma glucose during 75-g oral glucose tolerance
test, and A1C are equally appropriate.
• In patients with prediabetes, identify and, if
appropriate, treat other cardiovascular disease risk
factors.
PREDIABETES
American Diabetes Association Standards of Medical Care in Diabetes.
Classification and diagnosis of diabetes. Diabetes Care 2018; 40 (Suppl. 1): S13-S22
12. RISK-BASED SCREENING IN ASYMPTOMATIC CHILDREN
AND ADOLESCENTS
American Diabetes Association Standards of Medical Care in Diabetes.
Classification and diagnosis of diabetes. Diabetes Care 2018; 40 (Suppl. 1): S13-S22
13. • Testing for type 2 diabetes in asymptomatic people should
be considered in adults of any age who are overweight or
obese (BMI ≥25 kg/m2 or ≥23 kg/m2 in Asian Americans)
and who have 1 or more additional risk factors for diabetes
• For all patients, testing should begin at age 45 years.
• If tests are normal, repeat testing carried out at a minimum
of 3-year intervals is reasonable.
TYPE 2 DIABETES
American Diabetes Association Standards of Medical Care in Diabetes.
Classification and diagnosis of diabetes. Diabetes Care 2018; 40 (Suppl. 1): S13-S22
14. • To test for type 2 diabetes, FPG, 2-h plasma glucose
during a 75-g OGTT, and the A1C are equally
appropriate.
• In patients with diabetes, identify and treat other
cardiovascular disease risk factors.
American Diabetes Association Standards of Medical Care in Diabetes.
Classification and diagnosis of diabetes. Diabetes Care 2018; 40 (Suppl. 1): S13-
S22
15. • Testing for type 2 diabetes should be considered in children
and adolescents who are over weight or obese (BMI >85th
percentile for age and sex, weight for height >85th percentile,
or weight >120% of ideal for height) and who have additional
risk factors for diabetes (Table 2.5).
American Diabetes Association Standards of Medical Care in Diabetes.
Classification and diagnosis of diabetes. Diabetes Care 2018; 40 (Suppl. 1): S13-S22
16. Test for undiagnosed diabetes at the 1st prenatal visit in
those with risk factors, using standard diagnostic criteria.
Test for GDM at 24–28 weeks of gestation in pregnant
women not previously known to have diabetes.
Test women with GDM for persistent diabetes at 4–12
weeks postpartum, using the OGTT and clinically
appropriate non pregnancy diagnostic criteria.
GESTATIONAL DIABETES MELLITUS
(GDM)
American Diabetes Association Standards of Medical Care in Diabetes.
Classification and diagnosis of diabetes. Diabetes Care 2018; 40 (Suppl. 1): S13-S22
17. SCREENING AND DIAGNOSIS OF GDM: ONE-
STEP STRATEGY
American Diabetes Association Standards of Medical Care in Diabetes.
Classification and diagnosis of diabetes. Diabetes Care 2018; 40 (Suppl. 1): S13-S22
Screening for and diagnosis of GDM-One-step strategy
Perform a 75-g OGTT, with plasma glucose measurement
when patient is fasting and at 1 and 2h, at 24-28 weeks of
gestation in women not previously diagnosed with overt
diabetes,
The OGTT should be performed in the morning after an
overaight fast of at least 8 h.
The diagnosis of GDM is made when any of the following
plasma glucose values are met or exceeded:Fasting: 92
mg/dL (5.1 mmol/L)1h: 180 mg/dL (10.0 mmol/L)2h: 153
mg/dL (8.5 mmol/L)
18. American Diabetes Association Standards of Medical Care in Diabetes.
Classification and diagnosis of diabetes. Diabetes Care 2018; 40 (Suppl. 1): S13-S22
COMPREHENSIVE MEDICAL
EVALUATION AND ASSESSMENT OF
COMORBIDITIES
19. American Diabetes Association Standards of Medical Care in Diabetes.
Classification and diagnosis of diabetes. Diabetes Care 2018; 40 (Suppl. 1): S13-S22
A complete medical evaluation should be performed at the initial
visit to : Confirm the diagnosis and classify diabetes.
• Evaluate for diabetes complications and potential comorbid
conditions.
• Review previous treatment & risk factor control in patients with
established diabetes.
• Begin patient engagement in the formulation of a care
management plan.
• Develop a plan for continuing care.
COMPREHENSIVE MEDICAL EVALUATION
20. COMPREHENSIVE MEDICAL EVALUATION (2)
A follow-up visit should include most components of the
initial comprehensive medical evaluation including: interval
medical history; assessment of medication-taking behavior
and intolerance/side effects, Physical examination;
laboratory evaluation as appropriate to assess attainment of
A1C and metabolic targets; and assessment of risk for
complications, diabetes self-management behaviors,
nutrition, psychosocial health, and the need for referrals,
immunizations, or other routine health maintenance
screening.
American Diabetes Association Standards of Medical Care in Diabetes.
Classification and diagnosis of diabetes. Diabetes Care 2018; 40 (Suppl. 1): S13-S22
22. American Diabetes Association Standards of Medical Care in Diabetes.
Classification and diagnosis of diabetes. Diabetes Care 2018; 40 (Suppl. 1): S13-S22
COMPONENTS OF THE COMPREHENSIVE DIABETES
EVALUATION
23. American Diabetes Association Standards of Medical Care in Diabetes.
Classification and diagnosis of diabetes. Diabetes Care 2018; 40 (Suppl. 1): S13-S22
COMPONENTS OF THE COMPREHENSIVE DIABETES
EVALUATION
24. American Diabetes Association Standards of Medical Care in Diabetes.
Classification and diagnosis of diabetes. Diabetes Care 2018; 40 (Suppl. 1): S13-S22
COMPONENTS OF THE COMPREHENSIVE
DIABETES EVALUATION
25. American Diabetes Association Standards of Medical Care in Diabetes.
Classification and diagnosis of diabetes. Diabetes Care 2018; 40 (Suppl. 1): S13-S22
COMPONENTS OF THE COMPREHENSIVE DIABETES
EVALUATION
