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Diabetes: a brief introduction

The term diabetes mellitus describes a group of metabolic diseases characterized by hyperglycemia, which results from defects in insulin secretion, insulin action or both. 

Multiple Organ System Challenges 

Complications due to diabetes are a major cause of disability, reduced quality of life and premature death. Diabetes complications can affect various parts of the body, manifesting in different ways in different people. In its most severe forms, uncontrolled diabetes may result in acute, life-threatening complications due to ketoacidosis or a non-ketotic hyperosmolar state. 

Complications of Diabetes

Uncontrolled diabetes and the associated hyperglycemia leads to nephropathy, neuropathy, retinopathy, gastrointestinal issues, cardiovascular disease, and metabolic disorders such as ketoacidosis. All of these above conditions lead to additional chronic conditions, which in turn require steady monitoring by the patient, e.g. foot complications, wounds and other skin disorders.

Diabetes complications can be prevented or delayed by maintaining blood glucose, blood pressure and cholesterol levels as close to normal as possible. Many complications can be picked up in their early stages by screening programs that allow treatment to prevent them becoming more serious.  

Diagnosis & Early Detection

WHO acknowledge that easy access to basic diagnostics for diabetes is essential and diagnosis should be available in primary health care settings. Diabetes is diagnosed by measuring glucose in a blood sample taken when the patient is in a fasting state, or 2 hours after a 75 g oral load of glucose has been taken. Another method for diagnosing diabetes is by measuring glycated hemoglobin (HbA1c). This method can be used even if the patient is not in a fasting state. HbA1c reflects the average blood glucose concentration over the past few weeks, rather than the blood glucose concentration at the moment (which is reflected by the fasting and 2-hour glucose). 

Screening or not? For early detection of type 2 diabetes there are some evidence suggesting benefits to early detection and treatment, however there are no definitive evidence from randomized trials.

Screening & Diagnosis 

Diabetes should be diagnosed if one or more of the following criteria are met:

  • Fasting plasma glucose ≥ 7.0 mmol/L (126 mg/ dl)
  • Two-hour plasma glucose ≥ 11.1 mmol/L (200 mg/dl) following a 75g oral glucose load

Impaired Glucose Tolerance (IGT) should be diagnosed if both of the following criteria are met:

  • Fasting plasma glucose < 7.0 mmol/L (126 mg/ dl)
  • Two-hour plasma glucose 7.8-11.1 mmol/L (140 -200 mg/dl) following a 75g oral glucose load

Impaired Fasting Glucose (IFG) should be diagnosed if both of the following criteria are met:

  • Fasting plasma glucose 6.1-6.9 mmol/L (110-125 mg/ dl)
  • Two-hour plasma glucose < 7.8 mmol/L (140) following a 75g oral glucose load


Gestational diabetes mellitus
should be diagnosed at any time in pregnancy if one or more of the following criteria are met:

  • Fasting plasma glucose 5.1-6.9 mmol/L (92-125 mg/dl)
  • One-hour plasma glucose ≥ 10.0 mmol/L (180 mg/dl) following a 75g oral glucose load
  • Two-hour plasma glucose 8.5-11.0 mmol/L (153 -199 mg/dl) following a 75g oral glucose load

Diabetes in pregnancy should be diagnosed if one or more of the following criteria are met:

  • Fasting plasma glucose ≥ 7.0 mmol/L (126 mg/ dl)
  • Two-hour plasma glucose ≥ 11.1 mmol/L (200 mg/dl) following a 75g oral glucose load
  • Random plasma glucose ≥ 11.1 mmol/L (200 mg/ dl) in the presence of diabetes symptoms
 

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