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. In addition to performing the physical exam, what
additional work up might you order, the patient has fasted.
No
further work up
Oral
glucose tolerance test
Fasting
glucose estimation.(Correct
Answer)
Glycosylated
hemoglobin or HbA1c.
This
patient describes symptoms suspicious for diabetes mellitus, she has a history
of macrosomic infants, borderline hypertension and obesity. She also has a
family history of diabetes. The use of an oral glucose tolerance test for
diagnostic purposes in non-pregnant adults is not recommended. The use of
HbA1c for diagnostic purposes is controversial due to lower sensitivity. The
most appropriate test to order is a fasting glucose.
Under
the previous WHO and the NDDG criteria, the diagnosisof diabetes
is largely a function of which test is performed.Many individuals
who would have 2-h PG
200
mg/dl (11.1 mmol/l)in an OGTT are not tested with an OGTT because
they lack symptomsor because they have an FPG <140 mg/dl (7.8
mmol/l). Thus,if it is desired that all people with diabetes be
diagnosedand the previous criteria are followed, OGTTs must be
performedperiodically in everyone. However, in ordinary practice,
notonly is the OGTT performed infrequently, but it is usually notused even to confirm suspected cases (128).
In summary, thediagnostic criteria are now revised to 1) avoid the
discrepancybetween the FPG and 2-h PG cutpoint values and 2)
facilitateand encourage the use of a simpler and equally accurate
test—fastingplasma glucose—for diagnosing diabetes.Diabetes Care 25:S5-S20, 2002
200
mg/dl (11.1 mmol/l) in an OGTT are not tested with an OGTT because
they lack symptoms or because they have an FPG <140 mg/dl (7.8
mmol/l). Thus, if it is desired that all people with diabetes be
diagnosed and the previous criteria are followed, OGTTs must be
performed periodically in everyone. However, in ordinary practice,
not only is the OGTT performed infrequently, but it is usually not
used even to confirm suspected cases (