Type 1 diabetes – Type 1 diabetes (previously known as insulin-dependent, juvenile or childhood-onset) is characterized by deficient insulin production and requires daily administration of insulin. In 2017 there were 9 million people with type 1 diabetes; the majority of them live in high-income countries.
What is diabetes according to who?
WHO / Panos / Atul Loke People getting their fasting sugar checked for diabetes at government initiated Kamala Raman Nagar dispensary. © Credits Diabetes is a chronic, metabolic disease characterized by elevated levels of blood glucose (or blood sugar), which leads over time to serious damage to the heart, blood vessels, eyes, kidneys and nerves.
The most common is type 2 diabetes, usually in adults, which occurs when the body becomes resistant to insulin or doesn’t make enough insulin. In the past 3 decades the prevalence of type 2 diabetes has risen dramatically in countries of all income levels. Type 1 diabetes, once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition in which the pancreas produces little or no insulin by itself.
For people living with diabetes, access to affordable treatment, including insulin, is critical to their survival. There is a globally agreed target to halt the rise in diabetes and obesity by 2025. About 422 million people worldwide have diabetes, the majority living in low-and middle-income countries, and 1.5 million deaths are directly attributed to diabetes each year.
Both the number of cases and the prevalence of diabetes have been steadily increasing over the past few decades. Symptoms of type 1 diabetes include the need to urinate often, thirst, constant hunger, weight loss, vision changes and fatigue. These symptoms may occur suddenly. Symptoms for type 2 diabetes are generally similar to those of type 1 diabetes but are often less marked.
As a result, the disease may be diagnosed several years after onset, after complications have already arisen. For this reason, it is important to be aware of risk factors. Type 1 diabetes cannot currently be prevented. Effective approaches are available to prevent type 2 diabetes and to prevent the complications and premature death that can result from all types of diabetes.
These include policies and practices across whole populations and within specific settings (school, home, workplace) that contribute to good health for everyone, regardless of whether they have diabetes, such as exercising regularly, eating healthily, avoiding smoking, and controlling blood pressure and lipids.
The starting point for living well with diabetes is an early diagnosis – the longer a person lives with undiagnosed and untreated diabetes, the worse their health outcomes are likely to be. Easy access to basic diagnostics, such as blood glucose testing, should therefore be available in primary health care settings.
What is diabetic normal range?
Tests for type 1 and type 2 diabetes and prediabetes –
Glycated hemoglobin (A1C) test. This blood test, which doesn’t require not eating for a period of time (fasting), shows your average blood sugar level for the past 2 to 3 months. It measures the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells. The higher your blood sugar levels, the more hemoglobin you’ll have with sugar attached. An A1C level of 6.5% or higher on two separate tests means that you have diabetes. An A1C between 5.7% and 6.4% means that you have prediabetes. Below 5.7% is considered normal. Random blood sugar test. A blood sample will be taken at a random time. No matter when you last ate, a blood sugar level of 200 milligrams per deciliter (mg/dL) — 11.1 millimoles per liter (mmol/L) — or higher suggests diabetes. Fasting blood sugar test. A blood sample will be taken after you haven’t eaten anything the night before (fast). A fasting blood sugar level less than 100 mg/dL (5.6 mmol/L) is normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. If it’s 126 mg/dL (7 mmol/L) or higher on two separate tests, you have diabetes. Oral glucose tolerance test. For this test, you fast overnight. Then, the fasting blood sugar level is measured. Then you drink a sugary liquid, and blood sugar levels are tested regularly for the next two hours. A blood sugar level less than 140 mg/dL (7.8 mmol/L) is normal. A reading of more than 200 mg/dL (11.1 mmol/L) after two hours means you have diabetes. A reading between 140 and 199 mg/dL (7.8 mmol/L and 11.0 mmol/L) means you have prediabetes.
If your provider thinks you may have type 1 diabetes, they may test your urine to look for the presence of ketones. Ketones are a byproduct produced when muscle and fat are used for energy. Your provider will also probably run a test to see if you have the destructive immune system cells associated with type 1 diabetes called autoantibodies.
WHO guidelines for type 2 diabetes?
Diagnosis and treatment – Early diagnosis can be accomplished through relatively inexpensive testing of blood glucose. Treatment of diabetes involves diet and physical activity along with lowering of blood glucose and the levels of other known risk factors that damage blood vessels.
blood glucose control, particularly in type 1 diabetes. People with type 1 diabetes require insulin, people with type 2 diabetes can be treated with oral medication, but may also require insulin;blood pressure control; andfoot care (patient self-care by maintaining foot hygiene; wearing appropriate footwear; seeking professional care for ulcer management; and regular examination of feet by health professionals).
Other cost saving interventions include:
screening and treatment for retinopathy (which causes blindness);blood lipid control (to regulate cholesterol levels);screening for early signs of diabetes-related kidney disease and treatment.
What race has diabetes the most?
Prevalence of diagnosed diabetes was highest among American Indians/Alaska Natives (14.7%), people of Hispanic origin (12.5%), and non-Hispanic blacks (11.7%), followed by non-Hispanic Asians (9.2%) and non-Hispanic whites (7.5%) (Appendix Table 3).
What is ideal HbA1c level?
A normal A1C level is below 5.7%, a level of 5.7% to 6.4% indicates prediabetes, and a level of 6.5% or more indicates diabetes.
Is 7.8 blood sugar high?
Diagnosis – Type 2 diabetes is usually diagnosed using the glycated hemoglobin (A1C) test. This blood test indicates your average blood sugar level for the past two to three months. Results are interpreted as follows:
Below 5.7% is normal.5.7% to 6.4% is diagnosed as prediabetes.6.5% or higher on two separate tests indicates diabetes.
If the A1C test isn’t available, or if you have certain conditions that interfere with an A1C test, your doctor may use the following tests to diagnose diabetes: Random blood sugar test. Blood sugar values are expressed in milligrams of sugar per deciliter (mg/dL) or millimoles of sugar per liter (mmol/L) of blood.
Less than 100 mg/dL (5.6 mmol/L ) is normal.100 to 125 mg/dL (5.6 to 6.9 mmol/L ) is diagnosed as prediabetes.126 mg/dL (7 mmol/L ) or higher on two separate tests is diagnosed as diabetes.
Oral glucose tolerance test. This test is less commonly used than the others, except during pregnancy. You’ll need to fast overnight and then drink a sugary liquid at the doctor’s office. Blood sugar levels are tested periodically for the next two hours. Results are interpreted as follows:
Less than 140 mg/dL (7.8 mmol/L ) is normal.140 to 199 mg/dL (7.8 mmol/L and 11.0 mmol/L ) is diagnosed as prediabetes.200 mg/dL (11.1 mmol/L ) or higher after two hours suggests diabetes.
Screening. The American Diabetes Association recommends routine screening with diagnostic tests for type 2 diabetes in all adults age 35 or older and in the following groups:
People younger than 35 who are overweight or obese and have one or more risk factors associated with diabetes Women who have had gestational diabetes People who have been diagnosed with prediabetes Children who are overweight or obese and who have a family history of type 2 diabetes or other risk factors
What is the diabetes 15 15 rule?
After You Have Low Blood Sugar – If your low blood sugar was mild (between 55-69 mg/dL), you can return to your normal activities once your blood sugar is back in its target range. After you have low blood sugar, your early symptoms for low blood sugar are less noticeable for 48 to 72 hours.
Be sure to check your blood sugar more often to keep it from getting too low again, especially before eating, physical activity, or driving a car. If you used glucagon because of a severe low (54 mg/dL or below), immediately call your doctor for emergency medical treatment. If you have had lows several times close together (even if they’re not severe), you should also tell you doctor.
They may want to change your diabetes plan.
What is the ideal blood sugar level for type 2 diabetes?
What are blood sugar targets? – A blood sugar target is the range you try to reach as much as possible. These are typical targets:
Before a meal: 80 to 130 mg/dL. Two hours after the start of a meal: Less than 180 mg/dL.
Your blood sugar targets may be different depending on your age, any additional health problems you have, and other factors. Be sure to talk to your health care team about which targets are best for you.
What is the first-line management of type 2 diabetes?
What should the family physician do? – Mark : I would begin medical therapy with metformin and use sulfonylureas and insulin as second-line treatment options. If you use glitazones, watch for adverse events, including increased fluid retention, CHF, and cardiovascular events.
- Bob : CHF has been seen with glitazone use in the past.
- In 2002, the FDA recognized the increased rates of CHF associated with glitazones and required the makers of pioglitazone (Actos) and Avandia to strengthen the warnings concerning adverse cardiovascular events.
- Also, there have been numerous headlines and news reports on a meta-analysis published in the New England Journal of Medicine that documented a small but increased risk of death from cardiovascular causes in patients taking rosiglitazone.5 It has been said that the risk of death is small; however, even if the risk is small, why would you prescribe this drug at all? When prescribing drugs, you want a benefit, but with rosiglitazone, you are basically saying, “I have this drug that will cost you a lot of money, won’t help your heart, oh, and by the way, there is a small chance it may make you worse.” Any takers? Andrea : I agree.
Start with metformin. This study should also serve as a warning that abstracts may not reflect the true results of a study, even in journals like the New England Journal of Medicine, You should evaluate the study yourself before you change your clinical practice (or find a group of medical nerds like us to do it for you).
Glitazones are associated with fluid retention, increased CHF rates, and, possibly, increased rates of cardiovascular events compared with sulfonylureas and metformin. The FDA and the Canadian government have issued warnings about CHF and cardiovascular events with rosiglitazone. Metformin should be the first-line drug for managing type 2 diabetes. Insulin and sulfonylureas should be second line, and glitazones should be reserved for third line. Metformin is the only drug for type 2 diabetes that does not cause weight gain, which is an important advantage.
The data and conclusion in the abstract of an article may not be the same as the data in the paper. If you read only the abstract, you may be misled. A lot of studies use surrogate markers as outcomes (e.g., fasting or postprandial blood glucose, FEV 1 ). These are DOEs. What we care about are POEMs (e.g., stroke rates, MI rates, quality of life). Something can be statistically significant but clinically meaningless (for example, A1C difference of 0.08 percent).
Which diabetes test is most accurate?
– The A1C is considered the frontline test for diabetes, having first been recommended by the American Diabetes Association (ADA) in 2010, according to Dr. David B. Sacks, a member of the College of American Pathologists’ Clinical Chemistry Resources Committee.
The test is useful for long-term detection of blood sugar because glucose binds with red blood cells and remains affixed for up to 120 days, he said. Chang Villacreses said that the A1C test has become the standard analysis because it’s much easier to administer than the glucose tolerance test, which requires people to spend a minimum of two hours in the lab.
“Not everyone has that kind of time,” she said. “The A1C test is much easier but not as accurate,” said Chang Villacreses. “We suggest that care of each patient has to be individualized.” For example, she said, follow up with the glucose tolerance test when people at high risk of diabetes because of age, weight, diet, inactivity, family history, or other risk factors test negative on an A1C test.
“That’s a very practical solution and I’d definitely support that,” said Sacks. He also suggested that doing a fasting glucose test — which requires only a single blood test and a shorter fasting window — in conjunction with the A1C tests could yield more accurate results. People with an A1C blood sugar level of 6.5 percent or higher on two separate tests are considered to have diabetes.
An A1C blood sugar of between 5.7 and 6.4 percent indicates prediabetes. Below 5.7 is considered normal, according to ADA guidelines, With the glucose tolerance test, a blood sugar level of less than 140 mg/dL is considered normal. Between 140 and 199 mg/dL is considered prediabetes, and more than 200 indicates diabetes.
Why HbA1c is gold standard?
Abstract – HbA1c is an important measure in monitoring treatment and management decisions in diabetic patients. It reflects the mean blood glucose level during the preceding 6 to 8 weeks. But this is true only for the population as a whole, not the individual patient.
Differences between blood glucose and HbA1c values must be analysed precisely, because it is subject to numerous factors. HbA1c cannot replace blood glucose measurements for immediately assessing glucose metabolism and recognizing acute metabolic abnormalities. The mean HbA1c level predicts potential diabetic complications and is closely correlated with clinical angiopathic end-points.
The quality of metabolic regulation can be assessed from HbA1c and blood glucose levels at defined times. But because of the numerous influencing factors HbA1c can be used as gold standard only with limitations. Developments, as in Great Britain and the USA, which take HbA1c as relevant basis for treatment (“pay for performance”), lead in a completely wrong direction and contribute neither to the validity of documented values in structured therapeutic programmes nor do they stimulate improvement in the overall management of diabetes.
What is the AACE guidelines?
American Association of Clinical Endocrinology Disease State Clinical Review – Evaluation and Management of Immune Checkpoint Inhibitor-Mediated Endocrinopathies: A Practical Case-Based Clinical Approach – Kevin C.J. This updated guideline provides evidence-based recommendations regarding the identification, screening, assessment, diagnosis, and treatment for a range of individuals with various causes of adult growth-hormone deficiency (GHD) and patients with childhood-onset GHD transitioning to adult care.
Acromegaly is a disorder characterized by growth hormone (GH) hypersecretion, multisystem-associated morbidities, and increased mortality. In 2004, the American Association of Clinical Endocrinologists (AACE) published medical guidelines for the clinical management of acromegaly (1 ). The incidence of adrenal incidentaloma, a term coined in reference to the phenomenon of detecting an otherwise unsuspected adrenal mass on radiologic imaging, has been increasing and now approaches the 8.7% incidence reported in autopsy series.
This updated guideline provides evidence-based recommendations regarding the identification, screening, assessment, diagnosis, and treatment for a range of individuals with various causes of adult growth-hormone deficiency (GHD) and patients with childhood-onset GHD transitioning to adult care.
How do you know when to test for AGHD? This slide library will help you determine the answer and provide detailed information on testing and treatment of AGHD. Learn about our updated guideline for the care and management of people with or at risk for diabetes mellitus. The guideline features 170 updated and new evidence-based clinical practice recommendations for diabetes at every stage, including prevention, diagnosis, and treatment.
The 2021 AACE Advanced Diabetes Technology Guideline is a comprehensive, evidence based clinical practice guideline addressing the latest advancements in technology options for patients with diabetes. Key recommendations include key metrics for Continuous Glucose Monitoring (CGM), integration of technology with insulin pumps, and what health care professionals need to know in terms of safety.
- Looking for more resources to help you in treating your patients? You’ve come to the right place.
- Below is a list of the top articles from our official, peer-reviewed journal Endocrine Practice, selected especially for diabetes educators.
- This algorithm for the comprehensive management of persons with type 2 diabetes (T2D) was developed to provide clinicians with a practical guide that considers the whole patient, his or her spectrum of risks and complications, and evidence-based approaches to treatment.
Designed to equip adult primary care clinicians with evidence-based knowledge and increased competence about how to use diabetes technology and devices to guide and modify treatment approaches for patients with diabetes. AACE’s Advanced Diabetes Technology – Conversations and Collaborations is a free webinar designed to equip endocrine care team members on how to use diabetes technology and devices to guide and modify treatment approaches for persons with diabetes.
- In this 50-minute video presentation Dr.
- Pop-Busiu discusses diabetic neuropathies, evidence-based prevention and management strategies, current epidemiology trends and more.
- Recent reports of diabetic ketoacidosis (DKA) occur-ring in conjunction with sodium glucose-cotransporter 2 (SGLT-2) inhibitor therapy have raised concerns that these agents may increase the risk of DKA, especially among patients taking exogenous insulin.
On May 15, 2015, the U.S. Epidemiologic data have demonstrated significant increases of various cancers in people with obesity and diabetes. Recently, concern has emerged that antihyperglycemic medications may also be associated with an increased prevalence of multiple cancers; however, available data are limited and conflicting.1,2 The primary goal of prediabetes management is to normalize glucose levels and prevent or delay progression to diabetes and associated microvascular complications.
Epidemiology Overall, type 1 diabetes (T1D) accounts for approximately 5% of diabetes and affects about 20 million individuals worldwide. Among those younger than 20 years of age, T1D accounts for the majority of T1D cases (1,2). The current U.S. prevalence estimate of 1-3 million T1D patients may triple by 2050 due to a rising incidence of T1D (3).
Risk Factors The risk factors for the development of both prediabetes and type 2 diabetes mellitus (T2DM) are as follows: 1 There is a continuum of risk for poor patient outcomes as glucose tolerance progresses from normal to overt type 2 diabetes. AACE-defined glucose tolerance categories are listed in Table 1.1 Table 1.
Glucose Testing and Interpretation 1 The Comprehensive Care Plan As may be expected with a chronic disease that primarily affects middle-aged and older individuals, type 2 diabetes is usually complicated by other medical conditions. Comprehensive care of patients with diabetes requires a team of healthcare professionals.
Working with different healthcare providers allows the patient to learn in-depth information regarding their health and well-being. It also ensures that the patient’s needs are cared for and addressed.