Dr. Sofia Halacheva: One result above the norm is not enough to diagnose diabetes

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Dr. Sofia Halacheva: One result above the norm is not enough to diagnose diabetes
Dr. Sofia Halacheva: One result above the norm is not enough to diagnose diabetes

Dr. Halacheva, which laboratory tests are indicative of a diagnosis of "diabetes mellitus"?

- The following criteria are currently approved by the World He alth Organization for making this diagnosis:

- A random plasma glucose value above 11.1 mmol/l in a sample taken at any time of the day, regardless of the interval since the last meal, is indicative of diabetes. Of course, if the clinical signs characteristic of diabetes are present - increased urine output, increased fluid intake, unexplained weight loss, etc.

- The other criterion is when fasting plasma glucose is above 7.0 mmol/l. By "fasting" it should be understood that an 8-hour interval without food intake has been observed.

- Third - plasma glucose at the 2nd hour of an oral glucose-tolerance test (OGTT - known as a glucose load test), conducted according to WHO requirements with 75g glucose - over 11.1 mmol/l.

- In 2011, glycated hemoglobin (HbA1c) was added to the diagnostic criteria. HbA1c values above 6.5% are considered diagnostic.

Is one abnormal lab result enough to make the diagnosis?

- Once obtained a result above the specified values requires repetition. Except in cases where classic clinical symptoms of hyperglycemia are present. The same test can be repeated or a different one can be selected. If both tests are outside the permissible values, the diagnosis is confirmed. If a discrepancy occurs, only the test that has pathological values is repeated, and if the result is repeated, this is a confirmation of the diagnosis. However, keep in mind that we are talking about the laboratory side of the matter. The diagnosis is made by a specialist endocrinologist, who is obliged to take into account additional information for each specific patient.

Can laboratory screening be performed to detect diabetes mellitus?

- Screening tests should be carried out in people who are

certain risk factors are present

These are, for example: overweight, history of the disease in first-line relatives, arterial hypertension, HDL-cholesterol level below 0.9. Women who have given birth to a child weighing more than 4 kilograms or who have been diagnosed with gestational diabetes can rely on such screening. This includes people with cardiovascular disorders and those who lead a sedentary lifestyle. The convenient thing in this case is that the same laboratory tests - fasting plasma glucose, OGTT and HbA1c are used not only for diagnosis, but also for diabetes screening, as well as for detecting pre-diabetes. Here is the place to mention the existence of immunological markers that can be demonstrated in the blood long before the clinical appearance of diabetes. These are autoantibodies against various antigens in the islets of Langerhans of the pancreas. Their determination is recommended for assessing the risk of developing type I disease. This is already a question of people burdened with family and in patients with gestational diabetes.

How is the laboratory blood sugar level controlled after the diagnosis of "Diabetes"?

- Good blood sugar control should include measuring fasting blood sugar, that is, the so-called postprandial blood sugar. And this means - checking the blood sugar level 2 hours after eating and the glycated hemoglobin. When conducting a blood sugar profile, the postprandial blood sugar must be examined. The recommendations of the International Diabetes Federation for good glycemic control indicate fasting plasma glucose values of 4.0 to 6.1 mmol/l and postprandial plasma glucose below 7.8 mmol/l. Target therapeutic levels are higher - 7.5-8% in some patients, such as the elderly or patients with advanced complications. This also applies to

patients with many comorbidities

as well as those with a history of severe hypoglycemia. Therefore, an individual approach to each individual patient is considered the most correct.

How often are these indicators surveyed?

- HbA1c should be tested every 2-4 months in type I diabetes and every 3-6 months in type II diabetes. The frequency of examination of all indicators takes into account whether the desired level of glycemia is achieved, whether there are changes in therapeutic behavior, etc. factors.

What is glycated hemoglobin and what is its importance in diabetes control?

- This metric is known as the gold standard for assessing glycemic control in people with diabetes. It carries information about the average level of blood sugar for the three months preceding the examination. It has the following advantages: it is measured once per day, the test can be carried out at any time of the day and does not require special preparation. It is believed that it correlates to the greatest extent with the development of diabetic complications - retino-, nephro- and neuropathy. It is also used as a screening for prediabetes. The American Diabetes Association recommends that an HbA1c level between 5.7 and 6.4% be taken as an increased risk factor for future development of diabetes mellitus.

What other tests are recommended to ensure good diabetes control?

- Of course, good diabetes control doesn't just involve blood sugar control. This includes indicators for controlling risk factors, such as lipid profile, indicators of prothrombotic state, etc. To control kidney function, the emission of albumin in the urine is examined. In the case of type I diabetes, it must be carried out 5 years after the diagnosis - it is done once a year. In type II - immediately after the diagnosis of diabetes and with a frequency of 1 time per year. Every year, the serum creatinine level is measured and the glomerular filtration rate is calculated to determine the degree of chronic kidney damage, if any. Urine albumin/creatinine ratio is also used.

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