This document defines diabetes and provides classifications of the different types of diabetes. It discusses the key characteristics of type 1 diabetes, type 2 diabetes, and other specific types. Criteria are provided for diagnosing diabetes and prediabetes based on HbA1c levels, fasting plasma glucose levels, and oral glucose tolerance tests. Guidelines are also given for screening and diagnosing gestational diabetes.

1. Diabetes
Universidad de Sucre
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Jesús Turizo Hernández
Universidad de Sucre | Facultad de Ciencias de la Salud | Programa de Medicina

2. Atlas de la Diabetes de la Federación Internacional de Diabetes, 2013

3. Definición
 La diabetes es un grupo de enfermedades metabólicas caracterizada por
hiperglucemia resultante de defectos en la secreción de insulina, la acción
de la insulina, o ambos.
Diagnosis and Classification of Diabetes Mellitus. (2009). Diabetes Care, 33 (Supplement 1), pp. S62-S69.
Etimología
El término diabetes: aspectos históricos y lexicográficos. Panacea. Vol. V, n° 15. Marzo, 2004.
Del griego diabétes.
Del verbo diabaíno, ‘caminar’.
Del prefijo dia-, ‘a través de’ y báino, ‘andar, pasar’.
Ojos
Riñones
Nervios
Corazón
Vasos sanguíneos
Hiperglicemia crónica
Diagnosis and Classification of Diabetes Mellitus. (2009). Diabetes Care, 33 (Supplement 1), pp. S62-S69.
Definición

5. Número estimado de personas con diabetes en el mundo
y por región en 2015 y 2040 (20-79 años)

6. Adultos que murieron por diabetes, VIH/SIDA, tuberculosis, y malaria

7. La prevalencia de la diabetes

8. Diabetes por género

9. Diabetes en zonas urbanas y rurales

10. Prevalencia de personas con diabetes por edad y sexo, 2015

11. Los diez primeros países/territorios en número de personas
con diabetes (20-79 años), 2015 y 2040

12. Prevalencia ajustada por edad estimada de diabetes en adultos (20-79), 2015

13. Proporción (%) de personas que murieron por diabetes antes de los 60 años

14. Número de personas con tolerancia a la glucosa alterada
por grupo de edad, 2015 y 2040

15. Prevalencia ajustada por edad (%) de la tolerancia a la
glucosa alterada (20-79 años)

16. Diez primeros países/territorios en número de niños con
diabetes tipo 1 (< 15 años), 2015

17. Diez primeros países/territorios en número de nuevos casos de
diabetes tipo 1 (< 15 años) por 100.000 niños por año, 2015

18. Estimación de nuevos casos de diabetes tipo 1 (< 15 años)
por 100.000 niños por año, 2015

19. Estimaciones mundiales de hiperglucemia en el embarazo, 2015

20. Epidemiología
 La prevalencia de la diabetes mellitus tipo 2 en Colombia es
aproximadamente del 7,4% en hombres y del 8,7% en mujeres mayores de
30 años.
 La incidencia de diabetes mellitus tipo 1 en Colombia es relativamente baja
(de 3-4 por 100.000 niños <15 años) y la prevalencia se estima en un
0,07%.
 Los puntos de corte de cintura que mejor discriminan el exceso de grasa
visceral en Latinoamérica corresponden a 94 cm para hombres y 88 cm para
mujeres.
Aschner, P. (2015). Epidemiología de la diabetes en Colombia. Avances en Diabetología 31(3): 95-100.

21. Clasificación
 Diabetes tipo 1 (DM1).
 Diabetes tipo 2 (DM2).
 Otros tipos específicos de diabetes.
 Diabetes gestacional (DMG).
Diagnosis and Classification of Diabetes Mellitus. (2009). Diabetes Care, 33 (Supplement 1), pp. S62-S69.
Clasificación
Diabetes tipo 1 (DM1):
Destrucción de las células β, lo que conduce a la deficiencia
absoluta de insulina.
A. Inmunomediada.
B. Idiopática.
Diagnosis and Classification of Diabetes Mellitus. (2009). Diabetes Care, 33 (Supplement 1), pp. S62-S69.
Clasificación
Diabetes tipo 2 (DM2):
A. Predominantemente insulinorresistente con deficiencia
relativa de insulina.
B. Predominantemente con un defecto secretor de la insulina
con o sin resistencia a la insulina.
Diagnosis and Classification of Diabetes Mellitus. (2009). Diabetes Care, 33 (Supplement 1), pp. S62-S69.
Clasificación
Diagnosis and Classification of Diabetes Mellitus. (2009). Diabetes Care, 33 (Supplement 1), pp. S62-S69.
Otros tipos específicos de diabetes:
A. Defectos genéticos de la función de las células β:
1. Cromosoma 12, HNF-1α (MODY3).
2. Cromosoma 7, glucocinasa (MODY2).
3. Cromosoma 20, HNF-4α (MODY1).
4. Cromosoma 13, factor promotor de insulina-1 (IPF-1;
MODY4).
5. Cromosoma 17, HNF-1α (MODY5).
6. Cromosoma 2, NeuroD1 (MODY6).
7. ADN mitocondrial.
8. Otros.
B. Defectos genéticos en la acción de la insulina:
1. Resistencia a la insulina tipo A.
2. Leprechaunismo.
3. Síndrome de Rabson-Mendenhall.
4. Diabetes lipoatrófica.
5. Otros.
C. Enfermedades del páncreas exocrino:
1. Pancreatitis.
2. Trauma del páncreas.
3. Pancreatectomía.
4. Neoplasia del páncreas.
5. Fibrosis quística.
6. Hemocromatosis.
7. Pancreatopatía fibrocalculosa.
8. Otros.
D. Endocrinopatías:
1. Acromegalia.
2. Síndrome de Cushing.
3. Glucagonoma.
4. Feocromocitoma.
5. Hipertiroidismo.
6. Somatostinoma.
7. Aldosteronoma.
8. Otros.
E. Inducida por drogas o químicos:
1. Vacor.
2. Pentamidina.
3. Ácido nicotínico.
4. Glucocorticoides.
5. Hormonas tiroideas.
6. Diazóxido.
7. Agonistas β-adrenérgicos.
8. Tiazidas.
9. Fenitoína.
10. γ-interferón.
11. Otros.
F. Infecciones:
1. Rubéola congénita
2. Citomegalovirus
3. Otros.
G. Formas poco comunes de diabetes mediada Inmunológicamente:
1. Síndrome del hombre rígido.
2. Anticuerpos contra el receptor de la insulina.
3. Otros.
H. Otros síndromes genéticos algunas veces asociados con
diabetes:
1. Síndrome de Down.
2. Síndrome de Klinefelter.
3. Síndrome de Turner.
4. Síndrome de Wolfram.
5. Ataxia de Friedreich.
6. Corea de Huntington.
7. Síndrome de Lawrence-Moon-Biedl.
8. Distrofia miotónica.
9. Porfiria.
10. Síndrome de Prader-Willi.
11. Otros.

22. Fisiopatología
DeFronzo, R., Ferrannini, et al. (2015). Type 2 diabetes mellitus. Nature Reviews Disease Primers, p.15019.

23. Atlas de la Diabetes de la Federación Internacional de Diabetes, 2013

24. Criteria for the diagnosis of diabetes
FPG ≥126 mg/dL (7.0 mmol/L). Fasting is defined as no caloric intake for at least 8
h.
OR
2-h PG ≥200 mg/dL (11.1 mmol/L) during an OGTT. The test should be performed
as described by the WHO, using a glucose load containing the equivalent of 75 g
anhydrous glucose dissolved in water.
OR
A1C ≥6.5% (48 mmol/mol). The test should be performed in a laboratory using a
method that is NGSP certified and standardized to the DCCT assay.
OR
In a patient with classic symptoms of hyperglycemia or hyperglycemic crisis, a
random plasma glucose ≥200 mg/dL (11.1 mmol/L).
Criterios diagnósticos
Standards of Medical Care in Diabetes—2017. Diabetes Care. Volume 40, Supplement 1, January 2017

25. Criteria for testing for diabetes or prediabetes in asymptomatic adults
 1. Testing should be considered in overweight or obese (BMI ≥25 kg/m² or ≥23
kg/m² in Asian Americans) adults who have one or more of the following risk
factors:
 A1C ≥5.7% (39 mmol/mol), IGT, or IFG on previous testing
 first-degree relative with diabetes
 high-risk race/ethnicity (e.g., African American, Latino, Native American, Asian
American, Pacific Islander)
 women who were diagnosed with GDM
 history of CVD
 hypertension (≥140/90 mmHg or on therapy for hypertension)
 HDL cholesterol level <35 mg/dL (0.90 mmol/L) and/or a triglyceride level >250
mg/dL (2.82 mmol/L)
 women with polycystic ovary syndrome
 physical inactivity
Criterios diagnósticos
Standards of Medical Care in Diabetes—2017. Diabetes Care. Volume 40, Supplement 1, January 2017

26. Criterios diagnósticos
Standards of Medical Care in Diabetes—2017. Diabetes Care. Volume 40, Supplement 1, January 2017
Categories of increased risk for diabetes (prediabetes)
FPG 100 mg/dL (5.6 mmol/L) to 125 mg/dL (6.9 mmol/L) (IFG)
OR
2-h PG in the 75-g OGTT 140 mg/dL (7.8 mmol/L) to 199 mg/dL (11.0 mmol/L) (IGT)
OR
A1C 5.7 – 6.4% (39 – 47 mmol/mol)

27. Criteria for Clinical Diagnosis of the Metabolic Syndrome
Measure Categorical Cut Points
Elevated waist circumference
Population and country specific
definitions
Elevated triglycerides (drug treatment for
elevated triglycerides is an alternate
indicator)
≥150 mg/dL (1.7 mmol/L)
Reduced HDL-C (drug treatment for
reduced HDL-C is an alternate indicator)
<40 mg/dL (1.0 mmol/L) in males;
<50 mg/dL (1.3 mmol/L) in females
Elevated blood pressure
(antihypertensive drug treatment in a
patient with a history of hypertension is
an alternate indicator)
Systolic ≥130 and/or diastolic ≥85 mmHg
Elevated fasting glucose (drug treatment
Alberti, K., et al. (2009). Harmonizing the Metabolic Syndrome. Circulation, 120(16), pp.1640-1645.
Criterios diagnósticos

28. 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 2 h, at 24 – 28 weeks of gestation in women not previously diagnosed
with overt diabetes.
The OGTT should be performed in the morning after an overnight 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)
 1 h: 180 mg/dL (10.0 mmol/L)
 2 h: 153 mg/dL (8.5 mmol/L)
Standards of Medical Care in Diabetes—2017. Diabetes Care. Volume 40, Supplement 1, January 2017
Criterios diagnósticos

29. Screening for and diagnosis of GDM
Two-step strategy
Step 1: Perform a 50-g GLT (nonfasting), with plasma glucose measurement at 1 h,
at 24–28 weeks of gestation in women not previously diagnosed with overt diabetes.
If the plasma glucose level measured 1 h after the load is ≥130 mg/dL, 135 mg/dL,
or
140 mg/dL (7.2 mmol/L, 7.5 mmol/L, or 7.8 mmol/L), proceed to a 100-g OGTT.
Step 2: The 100-g OGTT should be performed when the patient is fasting.
The diagnosis of GDM is made if at least two of the following four plasma glucose
levels (measured fasting and 1 h, 2 h, 3 h after the OGTT) are met or exceeded:
Standards of Medical Care in Diabetes—2017. Diabetes Care. Volume 40, Supplement 1, January 2017
Criterios diagnósticos

30. Standards of Medical Care in Diabetes—2017. Diabetes Care. Volume 40, Supplement 1, January 2017
Criterios diagnósticos
Screening for and diagnosis of GDM
Two-step strategy
Carpenter/Coustan NDDG
Fasting 95 mg/dL (5.3 mmol/L) 105 mg/dL (5.8 mmol/L)
1 h 180 mg/dL (10.0 mmol/L) 190 mg/dL (10.6 mmol/L)
2 h 155 mg/dL (8.6 mmol/L) 165 mg/dL (9.2 mmol/L)
3 h 140 mg/dL (7.8 mmol/L) 145 mg/dL (8.0 mmol/L)
or

31. Metas de control
Summary of glycemic recommendations for many
nonpregnant adults with diabetes
A1C <7.0% (53 mmol/mol).
Preprandial capillary plasma glucose 80–130 mg/dL (4.4–7.2 mmol/L).
Peak postprandial capillary plasma glucose <180 mg/dL (10.0 mmol/L).
Standards of Medical Care in Diabetes—2017. Diabetes Care. Volume 40, Supplement 1, January 2017

38. Section changes
 The section was updated to include a new consensus on the staging of
type 1 diabetes and a discussion of a proposed unifying diabetes
classification scheme that focuses on b-cell dysfunction and disease
stage as indicated by glucose status.
Section 2. Classification and Diagnosis of Diabetes

39. Staging of type 1 diabetes
Stage 1 Stage 2
Stage
 Autoimmunity
 Normoglycemia
 Presymptomatic
 Autoimmunity
 Dysglycemia
 Presymptomatic
Diagnostic
criteria
 Multiple
autoantibodies
 No IGT or IFG
 Multiple autoantibodies
 Dysglycemia: IFG and/or IGT
 FPG 100–125 mg/dL (5.6–6.9 mmol/L
 2-h PG 140–199 mg/dL (7.8–11.0 mm
 A1C 5.7–6.4% (39–47 mmol/mol) or ≥
Section changes
Section 2. Classification and Diagnosis of Diabetes

40. Section changes
 The recommendation to test women with gestational diabetes mellitus
for persistent diabetes was changed from 6–12 weeks’ postpartum to
4–12 weeks’ postpartum to allow the test to be scheduled just before
the standard 6-week postpartum obstetrical checkup so that the results
can be discussed with the patient at that time of the visit or to allow the
test to be rescheduled at the visit if the patient did not get the test.
Section 2. Classification and Diagnosis of Diabetes

41. Section changes
 To reflect new evidence showing an association between B12
deficiency and long-term metformin use, a recommendation was added
to consider periodic measurement of B12 levels and supplementation
as needed.
Section 5. Prevention or Delay of Type 2 Diabetes

42. Section changes
 Based on recommendations from the International Hypoglycemia
Study Group, serious, clinically significant hypoglycemia is now
defined as glucose <54 mg/dL (3.0 mmol/L), while the glucose alert
value is defined as ≥70 mg/dL (3.9 mmol/L). Clinical implications are
discussed.
Section 6. Glycemic Targets

43. Classification of hypoglycemia
Level Glycemic criteria Description
Glucose alert value
(level 1)
≤70 mg/dL (3.9
mmol/L)
Sufficiently low for treatment with
fast-acting carbohydrate and dose
adjustment of glucose-lowering
therapy
Clinically significant
hypoglycemia (level 2)
<54 mg/dL (3.0
mmol/L)
Sufficiently low to indicate serious,
clinically important hypoglycemia
Severe hypoglycemia
(level 3)
No specific
glucose threshold
Hypoglycemia associated with severe
cognitive impairment requiring
external assistance for recovery
Section changes
Section 6. Glycemic Targets

44. Section changes
 To optimize maternal health without risking fetal harm, the
recommendation for the treatment of pregnant patients with diabetes
and chronic hypertension was changed to suggest a blood pressure
target of 120–160/80–105 mmHg.
Section 9. Cardiovascular Disease and Risk Management

46. Blood Glucose Meters Accuracy Requirements
The minimum accuracy performance criteria are:
 At glucose levels <100 mg/dL (5.55 mmol/L), 95% of results should be
within ±15 mg/dL (0.83 mmol/L) of laboratory results.
 At glucose levels ≥100 mg/dL (5.55 mmol/L), 95% of results should be
within ±15% of laboratory results.
System Accuracy Requirement A: Accuracy Plot

47. Blood Glucose Meters Accuracy Requirements
The minimum accuracy performance criteria are:
 99% of results must be within zones A & B of the Consensus Error Grid
(CEG) for type 1 diabetes.
System Accuracy Requirement B: Consensus Error Grid

48. Blood Glucose Meters Accuracy Requirements
System Accuracy Requirement B: Consensus Error Grid
Zone A No effect on clinical action
Zone B Altered clinical action – little or no effect on clinical outcome
Zone C Altered clinical action – likely to affect clinical outcome
Zone D Altered clinical action – could have signifcant medical risk
Zone E Altered clinical action – could have dangerous consequences

49. Gracias
Universidad de Sucre
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