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Diabete II
Diagnostic and Screening Criteria

Extraits par Esculape du 2010 Guidelines for diagnosis and screening for diabetes in the family practice
published in the April 1 issue of the American Family Physician.
From Medscape Medical News

"Many of the complications associated with diabetes, such as nephropathy, retinopathy, neuropathy, cardiovascular disease, stroke, and death, can be delayed or prevented with appropriate treatment of elevated blood pressure, lipids, and blood glucose.
The most prevalent cause is type 2 diabetes, which accounts for approximately 90% to 95% of all cases of diabetes in the United States, and which is associated with obesity and insulin resistance [Lire] .
Approximately 5% to 10% of diabetes cases are type 1, typically associated with autoimmune-mediated insulin deficiency. The American Diabetes Association defines diabetes as having 2 separate occasions of fasting blood glucose levels of at least 126 mg/dL after an 8-hour fast [Lire].

Testing of HbA1c level is useful both for diagnosis and screening
Diabetes can be diagnosed from a level of at least 6.5% on 2 separate occasions [Lire].
Limitations include low sensitivity and interference with interpretation by race, presence of anemia, and use of different medications.

Despite some inconsistencies in existing guidelines, most of these guidelines recommend diabetes screening for patients with hypertension or hyperlipidemia.

Classification of diabetes type or determination of the continued need for insulin may be facilitated by testing of C peptide levels.

Key Recommendations

  • Diabetes screening should be performed for patients with a sustained blood pressure higher than 135/80 mm Hg (level of evidence, A).
  • Diabetes screening should be performed for patients with hypertension or hyperlipidemia (level of evidence, B).
  • Diabetes can be diagnosed when the HbA1c value is greater than 6.5% on 2 separate occasions (level of evidence, C).
  • For patients at increased risk for diabetes, counseling is recommended regarding effective strategies to reduce risk, including weight loss and exercise (level of evidence, C).
Latent autoimmune diabetes in adults (LADA).

In an accompanying editorial, Jeff Unger, MD, from Catalina Research Institute in Chino, California, describes latent autoimmune diabetes in adults (LADA).
"...LADA is a slowly progressive form of autoimmune diabetes mellitus characterized by older age at diagnosis, the presence of pancreatic autoantibodies, and the lack of an absolute insulin requirement at diagnosis," Dr. Unger writes. "Although patients with LADA present with more preserved beta cell function than those with classic type 1 diabetes, they tend to have a rapid and progressive loss of beta cell function necessitating intensive insulin intervention. Family physicians care for most patients in the United States with type 2 diabetes and, therefore, should be aware that approximately 10 percent of these patients have LADA."
The review authors have disclosed no relevant financial relationships.

Am Fam Physician. 2010;81:863-870. Abstract

L’American Diabetes Association (ADA) recommande de dépister le diabète de type 2 chez tous les sujets en surpoids ou ayant un ou plusieurs autres facteurs de risque de diabète. En outre l’ADA préconise, même en l’absence de ces facteurs, de procéder à un dépistage systématique à partir de 45 ans, en le renouvelant tous les 3 ans. Ce dépistage, selon l’ADA, doit être couplé à celui de l’hypertension et des troubles lipidiques.
NB 2 : Cela correspond au dépistage du syndrome métabolique [Lire]
L´hémoglobine glyquée pour dépister le diabète ? Réponse chinoise Les auteurs concluent donc qu´une hémoglobine glyquée de 6.3 % est très spécifique pour la détection d´un diabète non connu jusque là chez les adultes chinois et donne une sensibilité similaire à celle d´un seuil glycémique > 7 mmol/l.

Glycated haemoglobin A1c for diagnosing diabetes in Chinese population: cross sectional epidemiological survey. Abstract : http://www.ncbi.nlm.nih.gov/pubmed/20478961 CONCLUSIONS: An HbA(1c) threshold of 6.3% was highly specific for detecting undiagnosed diabetes in Chinese adults and had sensitivity similar to that of using a fasting plasma glucose threshold of 7.0 mmol/l. This optimal HbA(1c) threshold may be suitable as a diagnostic criterion for diabetes in Chinese adults when fasting plasma glucose and oral glucose tolerance tests are not available. BMJ. 2010 May 17;340:c2249. doi: 10.1136/bmj.c2249.
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