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

Diabetes Mellitus Diagnostic Criteria

What are the Diabetes Mellitus diagnostic criteria?

Any one of the following is needed to diagnose 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. A fasting glucose level of ≥126 mg/dL.
3. A 2-hour glucose level with overload is ≥200 mg/dL during the Oral glucose tolerance test.

Diabetes mellitus diagnostic criteria

What is the diagnostic criteria for Impaired fasting glucose (IFG) :

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

What are the diagnostic criteria for Impaired glucose tolerance(IGT)?

1. When Fasting glucose level <126 mg/dL.
2. When the 2-hour oral glucose tolerance is between 140 and 199 mg/dL.

How will you manage diabetes mellitus?

1. The role of the lab is in the preclinical and management of diabetes mellitus.
2. Regular check-ups of glucose levels and urine.
3. After every three months, advise HbA1c.
4. Regular lab workup will prevent complications from diabetes mellitus.

How will you manage the preclinical workup of individuals at risk of developing diabetes?

1. This is advised in patients with a strong family history of diabetes mellitus.
2. This will delay or may even prevent the onset of type 1 diabetes mellitus.
3. The American Diabetes Association recommends immune-related markers in the first-degree relatives of individuals with diabetes.
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. Pulse level.
   3. Response to a glucose challenge.

What are the clinical markers for the diagnosis of diabetes mellitus?

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

What are the clinical factors of diabetic patients?

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

How will you manage diabetes mellitus?

• The biochemical testing of the patient will help diagnose and monitor the therapy.

What is the management in the acute stage of diabetes mellitus complications?

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

How will you manage the chronic stage complications of diabetes mellitus?

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 lipid levels.
3. Recommendations for glycemic control are:
   1. HbA1c
      1. Normal  = <6%
      2. The goal for diabetics = <7%
   2. Medical advice:
      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 falls below the detection level of routine reagent methods.
5. A lipid profile is advised yearly.

Microalbumin/creatinine ratio:

What are the Indications for the microalbumin/creatinine ratio?

1. In the case of diabetes Mellitus.
2. Patient with hypertension.
3. Patients with heart disease.
4. People over the age of 50 years.
5. H/O smoking.
6. In the case of obesity.
7. A person with family H/O kidney diseases, hypertension, and diabetes mellitus.
8. A urine excretion rate of greater than 200 µg/min indicates severe kidney disease (Nephropathy).
9. Once diabetic nephropathy is diagnosed, renal function deteriorates quickly.
10. A urinary albumin level of 30 to 300 mg/24 hours (20 to 200 µg/min) is considered microalbuminuria.

What is the mechanism of Urinary albumin excretion?

1. Patients with diabetes mellitus are more prone to develop kidney diseases.
2. Renal transplantation is needed in 1/3 of the patients with type 1 diabetes mellitus.
3. Diabetes is the most common cause of end-stage kidney disease in the USA and Europe.
4. Nephropathy is less common in type 2 diabetes.
5. Early detection of diabetic kidney disease depends upon the detection of urinary albumin.

Albumin urinary excretion

How will you summarize Urinary albumin excretion and interpretations?

What are the important facts about the Microalbumin/creatinine ratio?

1. Patients with diabetes mellitus are tested yearly to check their kidney disease status.
2. Albuminuria ≤0.3 g/day was detected only by the sensitive method.
3. This is the random urine sample (spot urine) where albumin concentration in mg is divided by the creatinine in gram (mg/g).
   1. Albumin/creatinine ratio (mg/g) predicts overnight excretion rate >30 µg/minute.
4. 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, it indicates macroalbuminuria.
5. No doubt, 24-hour sampling is the gold standard method.

American diabetes association recommendations:

Questions and answers: