Diabetes Mellitus:- Part 8 – Diabetes Mellitus Diagnostic Criteria, Microalbuminuria/creatinine ratio

December 20, 2021Chemical pathologyLab Tests

Diabetes Mellitus

Diabetes Mellitus diagnostic criteria:

Any one of the following is needed to diagnose the diabetes mellitus:

1. When there are classical signs and symptoms like polyphagia, polydipsia, and polyuria.
   1. With a glucose level of ≥200 mg/dL.
2. Fasting glucose level is ≥126 mg/dL.
3. 2-hours glucose level with overload is ≥200 mg/dL. during the Oral glucose tolerance test.

Impaired fasting glucose (IFG)diagnostic criteria:

• When fasting glucose level is  110 to 125 mg/dL.

Impaired glucose tolerance(IGT) diagnostic criteria:

1. When Fasting glucose level <126 mg/dL.
2. When 2-hours oral glucose tolerance is between 140 to 199 mg/dL.

Management role in diabetes mellitus:

1. The role of the lab is in the preclinical and for the management of diabetes mellitus.
2. Regular check-up of the glucose level and the urine.
3. It will prevent complications from diabetes mellitus.

Preclinical workup includes:

1. This is advised in patients where there is a strong family history of diabetes mellitus.
2. This will delay or may even prevent the onset of type 1 diabetes mellitus.
3. American diabetes association recommends immune-related markers in the first-degree relatives of diabetics.
4. Islet cell antibodies (ICA).
5. Insulin autoantibodies.
6. Glutamic acid decarboxylase antibodies.
7. Protein tyrosine phosphatase antibodies.
8. Genetic markers like HLA typing.
9. Insulin secretion like:
   1. Fasting level.
   2. Pulses level.
   3. Response to a glucose challenge.

Clinical markers for the diagnosis of diabetes mellitus are:

1. This mainly depends upon the presence of hyperglycemia.
2. OGTT may help to classify diabetes mellitus.
3. Insulin and C-peptide levels also help and assist the classification of diabetes mellitus.

The clinical factors are:

1. Blood glucose level.
2. Oral glucose tolerance test.
3. Presence of urine ketone bodies.
4. Insulin level.
5. Estimation of C-peptide level.

Management of the diabetes mellitus:

The biochemical testing of the patient will help in the diagnosis and monitoring of the therapy.

Management in the acute stage for:

1. Diabetic ketoacidosis.
2. Hypoglycemia.
3. Hyperosmolar nonketotic coma.

Management in the chronic stage is:

1. This is to control blood glucose concentration to decrease chronic complications like:
   1. Nephropathy.
   2. Retinopathy.
   3. Vascular diseases.
2. These complications can be controlled by:
   1. HbA1c.
   2. Urea.
   3. Creatinine.
   4. Urinary albumin excretion (microalbuminuria).
   5. Blood lipids level.
3. Recommendation for the control of glycemic control are:
   1. HbA1c
      1. Normal  = <6%
      2. The goal for diabetics = <7%
   2. Medical advise:
      1. If diabetes is unstable then advise HbA1c quarterly.
      2. If diabetes is controlled then advise HbA1c twice a year.
4. Microalbumin in the urine every year.
   1. This is the persistent microalbuminuria that is below the detection by the routine reagent methods.
5. Lipid profile advised yearly.
6. Albumin/creatinine ratio:
   1. This is the random urine sample (spot urine) where albumin concentration in mg is divided by the creatinine in gram.
   2. OR this is the ratio of albumin µg/L to creatinine mg/L, <30 is normal.
      1. A ratio of 30 to 300, indicates microalbuminuria.
      2. If this ratio is >300, indicates macroalbuminuria
   3. No doubt 24 hours sample is the gold standard method.
7. American diabetes association recommendations:
   

   Albumin excretion	Normal	Microalbuminuria	Clinical albuminuria
   Albumin excretion mg/day	<20	30 to 300	>300
   Albumin/g creatinine	<30	30 to 300	>300