Diabetes Diagnosis

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Through this PPT we can simply know how to diagnose a case of diabetes, the basic idea on diagnosis of DM

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Diabetes Mellitus :

Diabetes Mellitus By Dr.Sayeed Uddin Helal MS (Neurosurgery-in course), MPH(Epidemiology), MBBS,CCD (Diabetology) Ex-Registrar, Medical Care Unit, Centre for the Rehabilitation of the Paralysed (CRP)

Definition:

Definition Diabetes Mellitus is a metabolic disorder resulting in raised blood glucose (hyperglycemia) from defects in insulin secretion; insulin action (resistance) or both that arise from genetic as well as environmental factors.

Classification:

Classification On the basis of aetiology …. Type 1 Diabetes Type 2 Diabetes Other specific types( cushing syndrome,FCPD ) Gestational diabetes (GDM)

Epidemiology:

Epidemiology DM in adult population(Global) Prevalence (%) 6.6 7.8 Number of people with DM (million) 285 439 2010 2030 DM in adult (Bangladesh) 2010 Prevalence (%) 6.1 Number of people with DM (million) 5.7 Bangladesh will hold the 8 th position according to the total cases of DM in adult population (20 to 79 years) in 2030. In Bangladesh the Incidence is 4.2 per 100000 per year.

How patient presents:

How patient presents Asymptomatic With symptoms: (a) Typical (b) Atypical Typical Features Atypical Features Polyuria Non healing infection Polydipsia Repeated pregnancy loss, Pruritis vulve , Infertility Polyphagia Undue fatigability Weight loss with weakness Frozen shoulder

Diagnosis:

Diagnosis A patient is called Diabetic when FBS : ≥ 7.0 mmol /L Or 2 hrs after an oral standard glucose drink : ≥ 11.1 mmol /L Or HbA 1 : > 6.8%

OGTT Inference:

OGTT Inference Inference 0 min glucose level (venous plasma) mmol /L 120 min glucose level (venous plasma) mmol /L DM ≥ 7.0 ≥ 11.1 IGT <7.0 7.8 to < 11.1 IFG 6.1 to < 7.0 < 7.8 Normal < 6.1 < 7.8 OGTT tells one as Diabetic or IGT or IFG or Normal

FBS inference:

FBS inference Inference Glucose level ( venous plasma) mmol /L DM ≥ 7.0 IFG 6.1 to < 7.0 Normal <6.1 FBG can tell one as Diabetic or IFG but not as Normal. A person of either NFG or IFG if subjected to OGTT, may become Diabetic or IGT.

RBG Inference:

RBG Inference Inference RBG (venous plasma) mmol /L DM likely ≥11.1 DM uncertain 5.5 to < 11.1 DM unlikely < 5.5 RBG can only suspect one as Diabetic or Non-Diabetic. It is useful when a person is suspected on clinical ground.

Values for Diagnosis of DM and other categories of Hyperglycemia:

Values for Diagnosis of DM and other categories of Hyperglycemia Inference Whole blood Plasma Venous Capillary Venous DM (FBG) ≥ 6.1 ≥ 6.1 ≥ 7.0 DM ( 2 hrs glucose load) ≥ 10.0 ≥ 11.1 ≥ 11.1 IFG (FBG) 5.6 to < 6.1 5.6 to < 6.1 6.1 to < 7.0 IFG ( 2 hrs glucose load) < 6.7 < 7.8 <7.8 IGT (FBG) < 6.1 < 6.1 < 7.0 IGT ( 2 hrs glucose load) ≥ 6.7 ≥ 7.8 ≥ 7.8 Glucose concentration in mmol /L as per WHO expert committee 1999. revised in 2006

Some key notes:

Some key notes IGT and IFG are referred as Prediabetes . Patient with IFG or IGT have high risk of development of diabetes and cardiovascular diseases. Any type of DM can pass through the stages of IFG or IGT. These patients are treated by lifestyle modifications. Some cases may revert to Normal.

Continued…:

Continued… Glucose in urine (glycosuria) informs us that blood glucose of the person has crossed his/her renal threshold for glucose .It is not a diagnostic parameter of DM. So we can avoid the test: Corresponding urinary glucose/sugar.

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