Diagnosing diabetes

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Dear all,

For diagnosing diabetes,apart from the glucose intolerance test and the general symptoms typical of diabetes (polyuria,polydipsia,weight loss) ,are there any addtional lab tests or clinical tests that can be performed to diagnose diabetes?

Thank you

 

The glucone intolerance test is being used less often as it is quite a stressful test --> not a good thing on someone who is already sick.

The ADA criteria for diagnosis is:
1. Classical symptoms plus a random plasma glucose concentration > 11.1mmol/l
or
2. Fasting plasma glucose > 7.0mmol/l
or
3. 2 hour plasma glucose greater than 11.1mmol/l during oral glucose tolerance test

There are no other tests as nothing else is needed to make the diagnosis.

HOWEVER, it is not uncommon for other tests to be done to asisst management at the time of diagnosis.
For eg type I usually presents with ketoacidiosis, so there is going to be some eletrolyte tests done to assit it management
For eg type 2, as the 'clock has been ticking' for a while by the time the diagnosis is made, they are prbably going to be tested for kidney function and lipids

 

Thank you for your feedback.

How about urine tests? Is that a good diagnostic test for diabetes?

 

Useless test for diagnosis.

It has very poor sensitivity and not specific enough for diganosis- due to rasied renal threshold for glucose (mostly in type 1); its affected by fluid intake; affected by urine concentration; and many drugs can affect it

It may play a role in monitoring control over time in those with type 2 who generally have stable glucose levels and are diet controlled and have issues with BGM - also sometimes used to check for ketones, especially during pregnancy or acute illness.

 

This just turned up in my inbox:
Debate Rages on HbA1c for Diabetes Diagnosis

Full article

 

For diagnosis of DM the first port of call is normally via a fasting or random blood glucose. Oral glucose tolerance test is not commonly used in the UK. Urinalysis has it's place in a point of care setting but will need confirmation via blood tests anyway due to false negatives and false positives. Suspicions of DM may be raised if there is hyperlipidaemia but the latter is not diagnostic in itself. HbA1c is not used for diagnostic purposes in the UK but as a monitoring tool.

http://www.labtestsonline.org.uk/understanding/conditions/diabetes-4.html

 

Hi Graeme,

Thanks for your feedback.I agree we have been thought that HbA1c is used as a measuement of glycaemic control over time but it has been indicated as a diagnostic test in few resources as well.

Quick question:Isn't fasting blood glucose test same as the glucose intolerance test,where the patient is instructed to fast for at least 12 hours than blood glucose is tested at three intervals?

 

The guidlines for a fasting blood glucose is fasting for no food for > 8 hours (diabetes is diagnosed if its > 7.0mmol/l)

The protocol for OGTT:
-3 days of adequate carbohydrate intake and normal activity
-fasting or 10-16 hours prior to test
-oral glucose load of 75gms in 250-350mls of water
-blood sample are taken at before glucose load and at 1 and 2 hours after
Diabetes is diagnosed if the 2 hr one > 11.1mmol/l
IGT is diagnosed if 2 hour post glucose >7.8 and < 11.1mmol/l

 

World-Wide Standards for Glucose Test Coming Soon

Link

 

Hi Nikki

You may find this a helpful recourse

http://www.footindiabetes.org/

Hope it helps

cheers

Derek