Chapter 4: Endocrine and Metabolic Disorders

DIABETES MELLITUS (DM), TYPE 2 AND PREDIABETES

Population

• Nonpregnant adults, children, adolescents.

Recommendations

USPSTF 2015, ADA 2019, IDF 2017

• Screen as part of cardiovascular risk assessment if age 40–70 y and BMI >25.

• Screen asymptomatic adults of any age with BMI ≥25 and risk factor(s). Screen asymptomatic Asian-American adults of any age with BMI ≥23 and risk factor(s).

• Screen children and adolescents who are overweight (BMI ≥85th percentile) or obese (BMI ≥95th percentile) with additional risk factor(s) after the onset of puberty or after 10 y of age, whichever occurs first.

• Screen women who were diagnosed with gestational diabetes (GDM) every 3 y.

• Screen patients with prediabetes annually for the development of diabetes.

• Use a validated screening test such as the FINDRISC score.^a If unavailable, use fasting plasma glucose (FPG) as a screening test. If negative, the screening test should be repeated at least every 3 y. If positive, proceed to a diagnostic test. Confirmatory diagnostic tests include FPG, random blood glucose (RPG), 2-hour plasma glucose during a 75-g oral glucose tolerance test (OGTT), or HgbA1C. If diagnostic test is normal, repeat the diagnostic test every year.

Sources

• USPSTF. Abnormal Blood Glucose and Type 2 Diabetes Mellitus: Screening. 2015.

• ADA. Standards in Medical Care in Diabetes—2019, Abridged for Primary Care Providers. 2019;37(1):11-34.

• International Diabetes Federation. IDF Clinical Practice Recommendations for Managing Type 2 Diabetes in Primary Care. 2017. www.idf.org/managing-type2-diabetes

Comments

1. Repeat screening at least every 3 y in asymptomatic adults above the age of 40.

2. Screen and treat patients with prediabetes for modifiable cardiovascular risk factors such as hypertension and dyslipidemia.

3. Risk factors for diabetes and prediabetes in asymptomatic adults:

   1. First-degree relative with diabetes

   2. High-risk race/ethnicity (eg, African-American, Latino, Native American, Asian-American, Pacific Islander)

   3. History of CVD

   4. Hypertension

   5. HDL <35 and/or triglycerides >250

   6. Women with polycystic ovary syndrome (PCOS)

   7. Physical inactivity

   8. Increased abdominal waist circumference

   9. Clinical conditions associated with insulin resistance (eg, severe obesity, acanthosis nigricans)

4. Risk factors for diabetes and prediabetes in asymptomatic children:

   1. Maternal history of diabetes or GDM during the child’s gestation

   2. Family history of type 2 diabetes in first- or second-degree relatives

   3. High-risk race/ethnicity (eg, African-American, Latino, Native American, Asian-American, Pacific Islander)

   4. Clinical conditions associated with insulin resistance (eg, acanthosis nigricans, hypertension, dyslipidemia, PCOS, small-for-gestational-age birth weight)

5. Overweight or obese children and adolescents in whom type 2 diabetes is being considered should be tested for pancreatic autoantibodies to exclude the possibility of autoimmune type 1 diabetes.

OBESITY

Population

• All adults, children >6-y-old, and ...