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Tutorial 2: Diagnosing Type 2 Diabetes.The diagnosis of Type 2 Diabetes is dependent on measuring plasma glucose levels, with or without the presence of diabetic symptoms such as polydipsia, polyphagia and polyuria.
The diagnostic criteria as defined by the World Health Organisation are as follow: ________________________________________________________________________________________________________________ Fasting plasma glucose ≥ 7.0 mmol/l (126 mg/dl) or Plasma glucose concentration of ≥ 11.1 mmol/l (200mg/dl) 2 hours after the oral dose of a glucose tolerance test. ________________________________________________________________________________________________________________ One abnormal lab value detailed above is diagnostic in symptomatic individuals, whereas two are required to diagnose an asymptomatic person. ________________________________________________________________________________________________________________ It should be noted that children usually present with severe symptoms and diagnosis should then be based on a single raised blood glucose result, as above. Immediate referral to a Paediatric Diabetes Team should not be delayed. ________________________________________________________________________________________________________________ HbA1c- Glycated Haemoglobin. A form of haemoglobin that is measured primarily to identify the average plasma glucose concentration over prolonged periods of time. It is formed in a non-enzymatic glycation pathway by haemoglobin's exposure to plasma glucose. Normal levels of glucose produce a normal amount of glycated haemoglobin. As the average amount of plasma glucose increases, the fraction of glycated haemoglobin increases in a predictable way. This serves as a marker for average blood glucose levels over the previous months prior to the measurement. The 2010 American Diabetes Association Standards of Medical Care in Diabetes added HbA1c ≥ 48 mmol/mol (≥6.5%) as another criterion for the diagnosis of diabetes. HbA1c can be used as a diagnostic test for diabetes providing that stringent quality assurance tests are in place and assays are standardised to criteria aligned to the international reference values, and there are no conditions present which preclude its accurate measurement. |