Chapter 4: Endocrine and Metabolic Disorders

DIABETES MELLITUS (DM), TYPE 2 AND PREDIABETES

Population

• – Nonpregnant adults, children, adolescents.

Recommendations

USPSTF 2015, ADA 2020, IDF 2017

• – Screen as part of cardiovascular risk assessment if age 45–70 y.

• – 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) and have additional risk factor(s) after the onset of puberty or after 10 y of age, whichever occurs first.

• – Screen women planning pregnancy who are overweight or have one or more risk factors for diabetes.

• – 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 ADA risk test.^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-h 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 of medical care in diabetes—2020. Diabetes Care 2020;43(1):S4-S21.

• – 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 45.

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 (>140/90 or on meds for HTN)

   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.