China is a country with a high prevalence of diabetes, with nearly 10% of the population suffering from diabetes and about a quarter of the population having abnormal blood sugar. It is very important that diabetes is detected and controlled in a timely manner. Who needs to be screened for diabetes? Different populations (adults, children, pregnant women) have different situations. This article is based on the 2014 American Diabetes Association’s Clinical Diagnostic and Treatment Specifications for Diabetes and combines the situation of the national population.
I. Screening for type 2 diabetes in asymptomatic adults
1. All overweight individuals (BMI ≥25 kg/m2) need to be screened, especially when combined with any of the following risk factors.
(Note: BMI is body mass index, weight divided by height squared, weight in kilograms, height in meters)
1) Not exercising.
2) Diabetic first-degree relatives.
3) birth of an infant weighing > 4 kg or gestational diabetes.
4) hypertension.
5) HDL cholesterol < 0.9 35=""> 2.82 mmol/l (250 mg/dl).
6) polycystic ovary syndrome.
7) previous tests suggesting glycated hemoglobin ≥5.7%, impaired fasting glucose or abnormal glucose tolerance.
8) other clinical conditions associated with insulin resistance (e.g., severe obesity, acanthosis nigricans).
9) History of cardiovascular disease
2. screening for type 2 diabetes begins at age 45 years for persons of normal weight
3. If screening results are normal, repeat screening at least 3 years apart, and 1 year apart for those at high risk or with prediabetes.
2 Screening means are glycated hemoglobin, fasting glucose or 2-hour 75 g OGTT (oral glucose tolerance test).
2 Screen and treat other cardiovascular risk factors in patients with prediabetes.
Screening for diabetes in asymptomatic children (≤18 years)
Type 2 diabetes mellitus
Overweight (BMI >85th percentile for the same age and sex, weight >85th percentile for the same height, or weight >120% of ideal weight) plus one of the following risk factors.
1) Family history of type 2 diabetes in a first-degree relative or a second-degree relative
2) signs of insulin resistance or having insulin resistance-related diseases (acanthosis nigricans, hypertension, dyslipidemia, polycystic ovary syndrome, low birth weight)
3) Age of onset of diabetes in mother or gestational diabetes: 10 years, or screening at the beginning of puberty if puberty begins before 10 years of age, frequency: every 3 years.
Type 1
Relatives of type 1 diabetic patients should be screened for type 1 diabetes
III. Screening and diagnosis of gestational diabetes mellitus
One-step method of performing 75 g OGTT, measuring fasting, 1-hour and 2-hour plasma glucose, in women with previously undiagnosed diabetes at 24-28 weeks of gestation.
OGTT is performed in the morning, with a minimum of 8 hours fasting the night before.
Gestational diabetes is diagnosed by meeting any of the following.
1) Fasting: ≥92 mg/dL (5.1 mmol/L).
2) 1 hour: ≥180 mg/dL (10.0 mmol/L) l ≥153 mg/dL (8.5 mmol/L) Two-step 50 g GLT (glucose load test, non-fasting) to measure 1-hour plasma glucose, examined at 24-28 weeks of gestation in women with previously undiagnosed diabetes.
If 1-hour plasma glucose is ≥135 mg/dL (7.5 mmol/L), a 100-g OGTT is performed (step 2). 100-g OGTT should be performed on an empty stomach.
Diagnose gestational diabetes if 3-hour plasma glucose is ≥140 mg/dL (7.8 mmol/L).