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Author Topic: Screening for type 2 diabetes in health care setting
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Post Screening for type 2 diabetes in health care setting
on: March 8, 2012, 17:39
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March 5, 2012

Screening for type 2 diabetes in health care setting

Diabetes mellitus affects an estimated 25.8 million people in the United States. Type 2 diabetes, which accounts for 90% to 95% of all diagnosed cases, is the most common form of diabetes. Often asymptomatic in its early stages, type 2 diabetes remains undiagnosed in millions of people.

Although early detection and treatment may have the potential to reduce symptoms and prevent diabetic complications, the role of screening for type 2 diabetes has been debated. In contrast to diagnostic testing which performs tests on individuals who display symptoms, screening seeks to identify asymptomatic individuals who are at high risk for developing a disease.

A technical review on screening for type 2 diabetes from the Centers for Disease Control and Prevention’s Division of Diabetes Translation concluded that screening individuals as part of routine medical care in a clinical setting may be warranted. Currently, the American Diabetes Association (ADA) recommends that health care providers consider screening of adults at 3-year intervals beginning at age 45. More frequent screening and screening at a younger age should be considered for adults who are overweight (body mass index [BMI] ≥ 25 kg/m<sup>2</sup>) and have at least one of the following risk factors:
<ul>
<li>Family history of diabetes</li>
<li>African American, Hispanic, Native American, and/or Asian American or Pacific Islander race/ethnicity</li>
<li>History of gestational diabetes or delivered a baby weighing over 9 pounds</li>
<li>High-density lipoprotein (HDL) cholesterol level ≤ 35 mg/dl and/or triglyceride level ≥ 250 mg/dl</li>
<li>Hypertension (≥ 140/90 mmHg)</li>
<li>Polycystic ovary syndrome</li>
<li>Previously identified impaired glucose tolerance or impaired fasting glucose</li>
<li>Habitual physical inactivity</li>
<li>History of vascular disease</li>
</ul>
For children and adolescents (ages 11-17 years), ADA recommends screening every 2 years for overweight youth (BMI > 85<sup>th</sup> percentile for age and sex, weight for height > 85<sup>th</sup> percentile, or weight is > 120% of ideal for height) who have at least two of the following risk factors:
<ul>
<li>Family history of type 2 diabetes</li>
<li>African American, Hispanic, Native American, and/or Asian American or Pacific Islander race/ethnicity</li>
<li>Signs of insulin resistance (acanthosis nigricans, hypertension, dyslipidemia, polycystic ovary syndrome)</li>
</ul>
The fasting plasma glucose (FPG) test is considered the best screening test for type 2 diabetes, especially in clinical settings because it is easy to perform  and inexpensive. This test is taken in the morning and requires fasting. Fasting is defined as no food or beverage intake other than water for at least 8 hours before testing. The 75-g oral glucose tolerance test (OGTT) should be performed if the FPG is < 126 mg/dl and there is high suspicion for diabetes.
<div align=”center”>
<table border=”0″ cellspacing=”0″ cellpadding=”0″>
<tbody>
<tr>
<td valign=”top” width=”103″>
<p align=”center”></p>
</td>
<td valign=”top” width=”198″>
<p align=”center”>Fasting plasma glucose (FPG)</p>
</td>
<td valign=”top” width=”186″>
<p align=”center”>2-h PG (OGTT)*</p>
</td>
</tr>
<tr>
<td valign=”top” width=”103″>Normal</td>
<td valign=”top” width=”198″>
<p align=”center”>< 100 mg/dl</p>
</td>
<td valign=”top” width=”186″>
<p align=”center”>< 140 mg/dl</p>
</td>
</tr>
<tr>
<td valign=”top” width=”103″>Pre-diabetes</td>
<td valign=”top” width=”198″>
<p align=”center”>100-125 mg/dl</p>
</td>
<td valign=”top” width=”186″>
<p align=”center”>140-199 mg/dl</p>
</td>
</tr>
<tr>
<td valign=”top” width=”103″>Diabetes</td>
<td valign=”top” width=”198″>
<p align=”center”>≥ 126 mg/dl</p>
</td>
<td valign=”top” width=”186″>
<p align=”center”>≥ 200 mg/dl</p>
</td>
</tr>
</tbody>
</table>
</div>
*“2-h PG” refers to 2 hour postload plasma glucose during an OGTT.

Repeat testing on a different day is necessary to confirm diagnosis. Casual plasma glucose measurements, which do not require fasting, can be used as well (where a plasma glucose level ≥ 200 mg/dl is classified as diabetes).

For additional information:
<ol>
<li>American Diabetes Association. (2004). Screening for type 2 diabetes. Diabetes Care, 27, S11-S14.</li>
<li>Engelgau M, Venkat Narayan KM, & Herman WH (Centers for Disease Control and Prevention). (2000). Screening for type 2 diabetes. Diabetes Care, 23, 1563-1580.</li>
</ol>
By: Sherry Liu, MPH, Ph.D. Candidate

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1 Comments
  1. Myth #1: Carbohydrates are bad for you.

    All carbohydrates aren’t alike. Easily digested carbohydrates, such as those from white bread and white rice, if eaten often and in large quantities, may add to weight gain. But carbohydrates are also found in fruits, vegetables, beans, and dairy products; and these deliver essential vitamins, minerals, and fiber. Diabetes carbohydrates also give your body energy and help keep organs functioning properly.

    A system called the glycemic index measures how fast and how far blood sugar rises after you eat a food with carbohydrates. White rice, for example, is almost immediately converted to blood sugar (glucose), causing it to rise rapidly, and so has a high glycemic index. Whole grain bread is digested more slowly, making blood sugar climb more slowly and not as high. It has a low glycemic index. Whenever possible, select carbohydrates that is whole grain, such as whole grain bread, whole wheat pasta, and old fashioned oats.

    Myth #2. Vegetables mainly add fiber to your diabetic diet foods.

    Vegetables are excellent sources of fiber and they supply vitamins and minerals, with very few calories. Orange vegetables like carrots, and dark leafy greens, such as spinach and collards, are good sources of vitamin A, an important nutrient to keep your eyesight keen, your skin healthy, and your immune system strong. Broccoli, pepper, and tomatoes are full of vitamin C, which promotes healing and keeps keep ligaments, tendons, and gums healthy. And beans and lentils supply potassium, which enables the body to convert blood sugar into glycogen, a stored form of energy that’s held in reserve by the muscles and liver.

    Myth #3: To get calcium in your diabetic diet, you have to consume dairy products.

    Milk, yogurt, and cheese are rich in calcium, which is important for building and protecting bones, Calcium Sources but they’re not the only sources of this mineral. Today, many foods are fortified with calcium, including orange juice, soy milk, breads, and cereals. Other nondairy sources of calcium are canned salmon and sardines with bones, collard greens, broccoli, and almonds. If you find it difficult to get enough calcium from your diet, you can also take calcium and glucose supplements.
    Food for Type 2 Diabetes – Nutrition Mythbusters

    Myth #4: Meat, chicken, and fish are the best sources of protein.

    Foods with protein help your body build muscle and tissue, and provide diabetes vitamins and minerals. Animal sources—meat, poultry, fish, and dairy products–have what’s called complete protein, that is, they contain all the amino acids needed to build new proteins. Proteins from fruits, vegetables, grains, and nuts are called incomplete proteins—they’re missing one or more amino acids. But animal sources of protein have their drawbacks: red meat and poultry skin are high in fat, especially saturated fat (a healthy diabetic diet plan should have less than 10% of calories from saturated fat). If you eat meat, stick to lean cuts, chicken with the skin removed, and fish. If you want to try vegetable sources of protein, try beans, nuts, and whole grains.

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