This document discusses screening, diagnosis, and management of type 2 diabetes. It notes that a 2014 survey in Myanmar found a 10.5% diabetes rate. Screening involves using a risk assessment questionnaire to identify high-risk individuals, who then receive glycemic tests. The criteria for diagnosing diabetes according to international organizations are outlined. Tests for detecting prediabetes include fasting plasma glucose, oral glucose tolerance test, and A1C. The document reviews monitoring of blood glucose and targets for glycemic control in various situations such as for non-pregnant adults, hospital inpatients, and perioperative care.

1. Diabetes Mellitus
Department of Diabetes and Endocrinology
YGH
1

2. Screening & Diagnosis
of
of Type 2 Diabetes
Dr. Cho Mar
Lecturer
Department of Medicine
University of Medicine 1, Yangon
2

3. 2014 STEP survey – adults aged 25-64 years
• Diabetes – 10.5%
 Urban – 13.9%
 Rural – 7.3%
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Prediabetes 19.5%

4. Detection programmes
Step 1 - Identify high-risk individuals using a risk
assessment questionnaire
Step 2 - Glycaemic measure in high-risk individuals
IDF (2012) Global Guideline for Type 2 Diabetes : Screening & Diagnosis: 9-14 4

5. FINDRISK
score
• Screening tests are
followed by
diagnostic tests in
order to make the
diagnosis
5

6. 6

7. Criteria for Diagnosis of DM
ADA, Standard of Medical Care in Diabetes(2018) 7
FPS ≥ 126 mg/dl (7.0 mmol/L)
Or
2-h PG ≥ 200 mg/dl (11.1 mmol/L) during an OGTT
Or
A1C ≥ 6.5 % (48mmol/mol)
Or
In a patient with classic symptoms of hyperglycaemia or
hyperglycaemic crisis, RBG ≥ 200 mg/dl (11.1 mmol/L)

8. WHO Criteria
8
Fasting plasma glucose ≥ 7.0 mmol/l (126 mg/dl)
FPG ≥ 7.0 mmol/l (126 mg/dl) and/or 2-h PG ≥ 200
mg/dl(11.1 mmol/L) during an OGTT
A1C ≥ 6.5 % (48mmol/mol)
RBG ≥ 200 mg/dl (11.1 mmol/L) in the presence of
classical diabetes symptoms
Or
Or
Or

9. Categories of Increased risk for Diabetes
(Prediabetes)
ADA, Standard of Medical Care in Diabetes(2018).
10
FPS - 100 mg/dl (5.6 mmol/L) to 125 mg/dl (6.9
mmol/L) (IFG)
2-h PG - 140 mg/dl (7.8 mmol/L) to 199 mg/dl
(11.0mmol/L) during an 75-g OGTT (IGT)
A1C - 5.7 – 6.4 % (39 – 46 mmol/mol)

10. Tests for prediabetes
FPG & 2 HPPG after 75-g OGTT
A1C
equally appropriate
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11. Monitoring
1. Self-monitoring of Blood Glucose (SMBG)
2. Haemoglobin A1C (A1C)
3. Continuous Glucose monitoring (CGM)
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12. • SMBG - 2 – 3 times per week
- more frequent in poorly controlled patients
• A1C - at least 2 x annually (stable patient)
- quarterly (poorly controlled patients)
• CGM - a supplemental tool to SMBG in those with
hypoglycemia unawareness and/or frequent hypoglycemic
episodes
13

13. Glycemic Targets
1. Non-pregnant adults
2. In-patient - Critically ill or Non-critically ill individual
3. Perioperative care
14

14. Glycemic Recommendations for
Non-pregnant 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)
15

15. Approach to the Management
of Hyperglycemia
low high
newly diagnosed long-standing
long short
absent severeFew/mild
absent severeFew/mild
highly motivated, adherent,
excellent self-care capabilities
readily available limited
less motivated, nonadherent,
poor self-care capabilities
A1C
7%
more
stringent
less
stringent
Patient/Disease Features
Risks associated with hypoglycemia
& other drug adverse effects
Disease Duration
Life expectancy
Important comorbidities
Established vascular complications
Patient attitude & expected treatment efforts
Resources & support system
American Diabetes Association Standards of Medical Care in Diabetes.
Glycemic targets. Diabetes Care 2016; 39 (Suppl. 1): S39-S46

16. 17

17. Glycemic Targets for Critically Ill Individuals
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Insulin - preferred method for diabetes care in the hospital
• Initiate insulin starting at ≤180 mg/dL (10.0 mmol/L)
• target glucose range - 140 - 180 mg/dL (7.8-10.0 mmol/L)
More stringent targets
• 110 - 140 mg/dL (6.1-7.8 mmol/L)
•providing a lower target does not confer increased hypoglycemia risk

18. Glycemic Targets for non-Critically Ill Individuals
• For most – 140 - 180 mg/dL (7.8 - 10.0 mmol/L)
• A lower target (<140 mg/dL) – prior h/o successful tight
glycemic control and clinically stable
• Higher ranges –terminally ill, have severe comorbidities, or are
in in-patient care settings where frequent glucose monitoring is
not feasible
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19. Glycemic Targets for perioperative care
• Target – 70 -180 mg/dL (4 -10.0 mmol/L)
• Monitor – every 4 - 6 hours
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20. Take home message
• Universal screening of diabetes is not recommended
• Identify high-risk individuals using a risk assessment
questionnaire( FINDRISK score )
• No one test is preferred over another for diagnosis and
screening of diabetes
• The same tests are used to screen for and diagnose
diabetes and to detect individuals with prediabetes
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21. Take home message
• It is important to take anemia/hemoglobinopathies into
consideration when using the A1C to diagnose diabetes
• Monitoring is important
• There are different glycaemic targets for different
situations
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22. Thank you
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THANK YOU