1. How is the diagnosis of diabetes made ?

2. Why is diabetes important ? 1 – About 5% of the population are affected by it. 2 – It is the third leading cause of death in the USA

3. Although there are some clinical features for diabetes, its final diagnosis is made by laboratory methods.

4. There are two major subtypes of diabetes that the main pathway of their diagnosis is the same.

5. ADA (American Diabetes Association) recommends that : Fasting plasma glucose or oral glucose tolerance test should be considered in all asymptomatic people at age 45. Follow up testing is needed every 3 years.

6. Hyperglycemia should be differentiated from diabetes. In other word each hyperglycemia is not diabetes !.

7. There are 3 main tests for plasma glucose measurement. Plasma glucose measurement Fasting plasma glucose Random plasma glucose Glucose tolerance testing

8. Fasting plasma glucose : Plasma specimen collected after a 12 to 14 hour fast vary less among individuals than do specimens collected at other times.

9. Oral glucose tolerance test is more sensitive than fasting plasma glucose early in the course of type 2 diabetes. http://www.google.com/imgres?imgurl=http://www.medhelp.org/adam/graphics/images/en/19810.j pg&imgrefurl=http://www.medhelp.org/medical-information/show/5415/Oral-glucose-tolerance- test&usg=__AkwEFzretg5fSIHPAuUftrfk8io=&h=320&w=400&sz=27&hl=en&start=0&zoom= http://www.google.com/imgres?imgurl=http://www.medhelp.org/adam/graphics/images/en/19810.j pg&imgrefurl=http://www.medhelp.org/medical-information/show/5415/Oral-glucose-tolerance- test&usg=__AkwEFzretg5fSIHPAuUftrfk8io=&h=320&w=400&sz=27&hl=en&start=0&zoom= Plasma glucose is measured fasting,then every 30 minutes for 2 hours after an oral glucose load which is 75 g for nonpregnant adults and 1.75 g/kg for children up to 75 g. Glucose is dissolved in 300 ml of water and ingested over 5 minutes.

10. Patient Preparation For OGTT Discontinue medications which affect the test (when possible) Perform the test in morning after 3 days of unrestricted diet and activity Perform the test after 10- to 16- hour fast only in ambulatory subjects between 7AM and 9AM The patient should remain seated during the test without smoking cigarette

11. OGTT should not be performed on: Hospitalized patients Acutely ill patients Inactive patients

12. Abnormal result of any FBS, Plasma Glucose or 2h pp glucose with classic symptoms of diabetes = Diabetes 2h pp : 2-hour postload plasma glucose

13. Impaired tests but not exactly diabetes

14. Factors other than diabetes which may influence the oral glucose tolerance test 20% of OGTTs fall into the nondiagnostic category. The OGTT should be performed on two separate occasions before the results are considered abnormal

15. Prediabetes: Before people develop type 2 diabetes, they almost always have "prediabetes"—blood glucose levels that are higher than normal but not yet high enough to be diagnosed as diabetes. There are 57 million people in the United States who have prediabetes. Recent research has shown that some long-term damage to the body, especially the heart and circulatory system, may already be occurring during prediabetes. http://www.diabetes.org/diabetes-basics/prevention/pre-diabetes/

16. What goals and treatment modalities should be the focus of prediabetes management? As prediabetes progresses, drug therapies directed towards hyperglycemia and the individual coronary heart disease risk factors may be required. …. http://www.aace.com/meetings/consensus/hyperglycemia/hyperglycemia.pdf http://www.aace.com/meetings/consensus/hyperglycemia/hyperglycemia.pdf

17. References: Burtis-C, Ashwood-E, Bruns-D,Tietz Fundamental of Clinical Chemistry, 6 th Edition, Saunders, 2008 Henry- JB – Clinical Diagnosis & Management By Laboratory Methods, 19 th Edition, Saunders, 1996 McPhee-S J, Papadakis- M, Current Medical Diagnosis And treatment, 49 th Edition, Lange, 2010 http://www.google.com/imgres?imgurl=http://www.medhelp.org/adam/graphics/image s/en/19810.jpg&imgrefurl=http://www.medhelp.org/medical- information/show/5415/Oral-glucose-tolerance- test&usg=__AkwEFzretg5fSIHPAuUftrfk8io=&h=320&w=400&sz=27&hl=en&start=0& zoom= http://www.google.com/imgres?imgurl=http://www.medhelp.org/adam/graphics/image s/en/19810.jpg&imgrefurl=http://www.medhelp.org/medical- information/show/5415/Oral-glucose-tolerance- test&usg=__AkwEFzretg5fSIHPAuUftrfk8io=&h=320&w=400&sz=27&hl=en&start=0& zoom= http://www.diabetes.org/diabetes-basics/prevention/pre-diabetes http://www.aace.com/meetings/consensus/hyperglycemia/hyperglycemia.pdf