Mrs.
S is a 45-yr. old woman who presents with a 2 month history of fatigue and
excessive thirst. She is a new patient to your practice, relevant history
includes possible borderline hypertension, obesity and two children whose
birth weights exceeded 9 lbs. She is a 1-2 pack a day smoker and family
history is significant for premature CAD, hypertension and diabetes. Her exam
is normal and BP is 135/82 mmHg.
Lab
results. Fasting Glucose 138 mg/dl. Other results include a total cholesterol
215, HDL-C 31 mg/dl. After informing the patient of her results you would:
Make
a diagnosis of impaired fasting glucose and refer her to a nutritionist
Perform
a further fasting glucose measurement.
Make
a diagnosis of type 2 diabetes and refer her to a nutritionist
Perform
a HbA1c
The
American Diabetes Association recommended new standards for the diagnosis of
diabetes in 1997. A fasting glucose of greater than or equal to 126 mg/dl
(7.0mmol) confirmed on a separate day is the preferred diagnostic
criteria for diabetes. Also a diagnosis can be based on symptoms, thirst,
polyuria etc. accompanied by an elevated glucose level >200mg/dl and
confirmed on a separate day. As noted above the HbA1c is not used for
diagnostic purposes.
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