Diabetes Mellitus:- Part 8 – Diabetes Mellitus Diagnostic Criteria, Microalbuminuria/creatinine ratio
Diabetes Mellitus diagnostic criteria:
Any one of the following is needed to diagnose the diabetes mellitus:
- When there are classical signs and symptoms like polyphagia, polydipsia, and polyuria.
- With a glucose level of ≥200 mg/dL.
- Fasting glucose level is ≥126 mg/dL.
- 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:
- When Fasting glucose level <126 mg/dL.
- When 2-hours oral glucose tolerance is between 140 to 199 mg/dL.
Management role in diabetes mellitus:
- The role of the lab is in the preclinical and for the management of diabetes mellitus.
- Regular check-up of the glucose level and the urine.
- It will prevent complications from diabetes mellitus.
Preclinical workup includes:
- This is advised in patients where there is a strong family history of diabetes mellitus.
- This will delay or may even prevent the onset of type 1 diabetes mellitus.
- American diabetes association recommends immune-related markers in the first-degree relatives of diabetics.
- Islet cell antibodies (ICA).
- Insulin autoantibodies.
- Glutamic acid decarboxylase antibodies.
- Protein tyrosine phosphatase antibodies.
- Genetic markers like HLA typing.
- Insulin secretion like:
- Fasting level.
- Pulses level.
- Response to a glucose challenge.
Clinical markers for the diagnosis of diabetes mellitus are:
- This mainly depends upon the presence of hyperglycemia.
- OGTT may help to classify diabetes mellitus.
- Insulin and C-peptide levels also help and assist the classification of diabetes mellitus.
The clinical factors are:
- Blood glucose level.
- Oral glucose tolerance test.
- Presence of urine ketone bodies.
- Insulin level.
- 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:
- Diabetic ketoacidosis.
- Hyperosmolar nonketotic coma.
Management in the chronic stage is:
- This is to control blood glucose concentration to decrease chronic complications like:
- Vascular diseases.
- These complications can be controlled by:
- Urinary albumin excretion (microalbuminuria).
- Blood lipids level.
- Recommendation for the control of glycemic control are:
- Normal = <6%
- The goal for diabetics = <7%
- Medical advise:
- If diabetes is unstable then advise HbA1c quarterly.
- If diabetes is controlled then advise HbA1c twice a year.
- Microalbumin in the urine every year.
- This is the persistent microalbuminuria that is below the detection by the routine reagent methods.
- Lipid profile advised yearly.
- Albumin/creatinine ratio:
- This is the random urine sample (spot urine) where albumin concentration in mg is divided by the creatinine in gram.
- OR this is the ratio of albumin µg/L to creatinine mg/L, <30 is normal.
- A ratio of 30 to 300, indicates microalbuminuria.
- If this ratio is >300, indicates macroalbuminuria
- No doubt 24 hours sample is the gold standard method.
- 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