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Glucose Tolerance Test Diabetes Mellitus

Glucose Tolerance Test Diabetes Mellitus. Dr. David Gee FCSN 442 - Nutrition Assessment Laboratory. Prevalence 2006. 20.8 million Americans 7% population 9.6% adults over 20 years 21% adults over 60 years 30% undiagnosed 6.2 million undiagnosed 41 million with ‘pre-diabetes’.

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Glucose Tolerance Test Diabetes Mellitus

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  1. Glucose Tolerance TestDiabetes Mellitus Dr. David Gee FCSN 442 - Nutrition Assessment Laboratory

  2. Prevalence2006 • 20.8 million Americans • 7% population • 9.6% adults over 20 years • 21% adults over 60 years • 30% undiagnosed • 6.2 million undiagnosed • 41 million with ‘pre-diabetes’

  3. Implications of the Diabetes Control and Complications TrialDiabetes Care 25:S25-S27, 2002 • Conventional Treatment vs Intensive Treatment • IT had lower HA1C and FBG • Average 7 year follow up • Measured outcomes: • Retinopathy, nephropathy, neuropathy • Results: • 60% reduction in risk in intensive treatment group

  4. Report of the Expert Committee on the Diagnosis and Classification ofDiabetes Mellitus Diabetes Care 28:S4-S36, 2005 See at Diabetes.org For health professionals 2005 clinical practice recommendations

  5. Criteria for testing for DM in assymptomatic, undiagnosed patients • > 45 yrs, every 3 yrs (if normal) • < 45 yrs, every 3 yrs if: • BMI > 25 and any of the following • 1st degree relative with DM • Blacks, Hispanic, Native American, Asian American • Habitually inactive • Hx Gestational Diabetes or baby > 9 lbs • History of vascular disease

  6. Criteria for testing for DM in assymptomatic, undiagnosed patients • < 45 yrs, every 3 yrs if: (cont.) • Hypertension (>140/90) • HDL < 35 mg/dl • TG > 250 mg/dl • previous Dx of impaired glucose tolerance or impaired fasting glucose

  7. Testing of children for Type 2 Diabetes • Criteria • Overweight (BMI >85th percentile for age and sex, weight for height >85th percentile, or weight >120% of ideal for height) • Plus any two of the following risk factors • Family history of Type 2 DM, 1o or 2o • Native American, black, asian, latino • Signs of insulin resistance (acanthosis nigricans, hypertension, dyslipidemia) • Age of initiation: 10 yrs or onset of puberty • Frequency – every two years • Test: FBG test preferred

  8. Acanthosis nigricans

  9. Fasting Blood Glucose • > 8 hr fast • DM if FBG > 126 mg/dl (7.0mM) • on 2 occasions • Pre-Diabetes • Impaired fasting glucose (IFG) • if : 110 - 125 mg/dl

  10. Casual Plasma Glucose • Casual is defined as any time of day without regard to time since last meal • > 200 mg/dl (11.1mM) plus • Symptoms of diabetes • Polyuria, polydipsea, unexplained weight loss • Confirm on subsequent visit with fasting blood glucose or oral glucose tolerance test

  11. Glucose Tolerance Testing • for • adults with impaired FBG • during pregnancy if at risk • Procedure • Following 8 hour fast • Glucose dose = 1.75g/kg IBW • Maximum 75 g dose (BW<43kg, 94lbs) • 25 g/dl glucose test solution • Test at 2 hours

  12. Diagnostic Criteria • DM if [glu] > 200 mg/dl at 2 hours • IGT if [glu] >140 - 199 at 2 hours • normal if [glu] < 140 mg/dl • IGT and IFT recently termed “pre-diabetic”

  13. Hemoglobin A1cglycated hemoglobin • Average lifespan of red blood cells • ~ 120 days (4 months) • Glycosylation of blood proteins in proportion to blood glucose concentration • Normal: 5% • Goal for diabetics: < 7%

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