02 Screening & Diagnosis

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Clinical Practice Guidelines:Management of

Type 2 Diabetes Mellitus

(4thEdition 2!!"

Topic Two:

#creening $ Diagnosis


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%b&ecti'e of presentation

)hy screen*

%b&ecti'e of screening

+ndications #creening methods

#ummary


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,

Pre'alence of Diabetes among Malaysian -dults

(-ge .,! years/ comparison 01M# ++ $ +++


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#creening $ Diagnosis

Objective

To detect prediabetes and diabetes in

specific high ris3 population groups and toensure timely and appropriate

management

Strategy

#creening for high ris3 group

#electi'e screening according to criteria


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)ho should be screened*:

#ymptomatic

-ny indi'idual 5ho has symptoms suggesti'e of

DM (tiredness/ lethargy/ polyuria/ polydipsia/

polyphagia/ 5eight loss/ pruritis 'ul'ae/ balanitis

must be screened6


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Who should be screened?:

Asymptomatic

Testing should be considered in all adults who are overweight [body

mass index !"#$ % &' (g)m&or waist circum*erence W+$ % ,- cm

*or women . % /- cm *or men0 and have additional ris( *actors:

Dyslipidaemia either high density lipoprotein (1D8 cholesterol 9 !6"

mmol8 or triglycerides (TG . ;6< mmol8

1istory of cardio'ascular disease (C=D 1ypertension (> ;4!"! mm1g or on therapy for hypertension +mpaired Glucose Tolerance (+GT or +mpaired ?asting Glucose (+?G on

pre'ious testing ?irstdegree relati'e 5ith diabetes

%ther clinical conditions associated 5ith insulin resistance (e6g6/ se'ereobesity and acanthosis nigricans

Physical inacti'ity )omen 5ith polycystic o'arian syndrome (PC%# )omen 5ith history of gestational diabetes should be screened for diabetes

annually6


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,! years6


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Screening: +hildren and

Adolescent Children and adolescents 5ho are o'er5eight (BM+

.@thpercentile for age and se/ or 5eight .;2!A ofideal and ha'e any t5o of the follo5ing ris3 factorsshould be screened for prediabetes and diabetes6

?amily history of T2DM in first or second degreerelati'e Maternal history of GDM Ethnicity (those of +ndian ethnic bac3ground are at

higher ris3s of de'eloping T2DM

#igns of insulin resistance or conditions associated5ith insulin resistance (acanthosis nigricans/hypertension/ dyslipidaemia/ PC%#


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;!

7revalence o* 8iabetes by 9ace 2

Aged 1, yrs

0ational Pre'alence ;;6A

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,&'2---$,&'2---$ '132---$'132---$

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!urdens $ !urdens $


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;;

#creening #chedule

#creening should be done annually for

adults6

+n children and adolescents/ screen e'ery

t5o years starting at the age of ;! years

old or at onset of puberty if puberty occurs

at a younger age6


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;2

#creening: Pregnant )omen

Pregnant 5omen should be screened if they ha'e any ofthe follo5ing ris3 factors:

BM+ . 2< 3gm2

Pre'ious macrosomic baby 5eighing 4 3g or abo'e Pre'ious gestational diabetes mellitus (GDM ?irstdegree relati'e 5ith diabetes Bad obstetric history

Glycosuria at the first prenatal 'isit Current obstetric problems (essential hypertension/pregnancy induced hypertension/ polyhydramnios andcurrent use of steroids

-ge abo'e 2 years


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;,

#creening: Pregnant )omen

#creening is done using the


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=alues for Diagnosis

+n the symptomatic indi'idual/ one abnormal glucose

'alue is diagnostic

+n the asymptomatic indi'idual/ 2 abnormal glucose

'alues are reuired

;asting 9andom

=enous Plasma Glucose > ;;6; mmol8


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;

Diagnostic =alues %GTT

O


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;7

#creening Test

#creening can be done by measuring randomblood glucose (capillary blood/ using glucosemeters and strips6

+n children and adolescents/ follo5 the samescreening procedure6


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; ,! years6

+n children and adolescents at ris3 of de'eloping diabetes/screening should be initiated at ;! years old or at onset ofpuberty if puberty occurs at a younger age6 #creening is

performed e'ery t5o years6 More freuent andor earlier testing 5ith either a ?PG or 2

hour plasma glucose in a


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2!

Thank you

02 Screening & Diagnosis

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