Diagnosis of diabetes

Diabetic symptoms Diabetic symptoms + venous sample for : –Random venous ≥ 11.1 mmol/l ( ) –Fasting glucose > 7(<6.1) –OGTT ≥ 11.1(<7.8) –HbA1c ≥ 6.5(<6)

Asymptomatic Plasma venous confirmation + 2nd blood test (3/12) (random/fasting/OGTT)

Oral Glucose Tolerance Test (OGTT) Fast 15h 75g glucose in 300ml water in 5min After 2h: normal < 7.8 IGT DM ≥ 11.1

HbA1c Glycosylation of Hg at rate proportional to : red cell life span blood glucose concentration Measure of blood glucose over 60 days If HbA1c > 6.5% = type 2 diabetes (mean 8.5)

HbA1c Not appropriate in: –Type 1, young –Symptoms < 2/12 –Medications causing glucose (steroids, antipsychotics) –Pregnancy

HbA1c Not appropriate in: –Anaemias/haemoglobinopathies –CKD 4/5 –Liver disease

Pre-diabetes Pre-diabetes (impaired gluose tolerance, impaired fasting glucose): HbA1c: 6-6.4% Fasting glucose mmol/l (normal < 6.1) IGT OGTT , Fasting < 7 IFG OGTT < 7.8, Fasting < 7

Pre-diabetes Cardiovascular risks Progression to diabetes ~ 50% over 10y Annual review: glucose regulation CV risk factors

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