Practical Implementation Tips: Type 2 Diabetes (T2DM) 1. Identify those at high risk of T2DM on your practice register The State of the nation 2016 (England): time to take control of diabetes1 report from Diabetes UK warns us that 5 million people in England are at high risk of developing T2DM. We have high quality evidence from several international diabetes prevention studies2 that early lifestyle intervention can reduce both long-term progression to T2DM, and long-term incidence of cardiovascular & all-cause mortality. Based on this evidence, the NHS Diabetes Prevention Programme3 was launched during 2016 to provide individualised lifestyle support for those at high risk of T2DM. NICE Public Health Guidance 38 “Prevention of T2DM …show more content…
If repeat test is also >48mmol/mol, then a diagnosis of T2DM can be established o If HbA1c 42-47mmol/mol this suggests high risk of diabetes; follow flowchart above o If HbA1c 30kg/m2 • Previous macrosomic baby weighing >4.5kg • A family history of diabetes (1st degree relative with diabetes) • A minority ethnic background with a high prevalence of diabetes (e.g. South or East Asian, Middle Eastern, Afro-Caribbean, Hispanic) • Previous GDM • 2+ glycosuria on antenatal screening (or 1+ on two or more occasions during pregnancy) NICE NG3 Diabetes in Pregnancy11 recommend we diagnose GDM as follows: • A FBG ≥5.6mmol/l or a 2-hour blood glucose post 75g oral glucose tolerance test ≥7.8mmol/l • As you can see, these thresholds are much lower than we would use to diagnose T2DM in the non-pregnant individual; we need to ensure that we do not miss this significant diagnosis GDM greatly increases the risk of future T2DM12, however, many women with GDM are unfortunately lost to follow-up after pregnancy, often understandably due to busy family lives13. NICE NG3 Diabetes in Pregnancy11 recommend we follow-up those with GDM as follows: • Offer lifestyle advice and check a FBG at 6-13 weeks after birth in those women with GDM. Do not routinely offer an oral glucose tolerance test o Pragmatically, this could comprise part of the routine 6-week post-partum check • If the FBG is ≥7mmol/l, a diagnosis of T2DM can be
Diagnosis of diabetes mellitus involves; patient history and physical examination. Blood tests including; FBG level exceeding 7.0mmol/l, OGTT level exceeding 11.0mmol/l using a 75g glucose load, postprandial blood glucose, HbA1c over a 2-3 month period >8%, lipid profile, serum urea and serum creatinine, electrolytes. Complete urinalysis. (Brown & Edwards, 2012)
Importantly, If the FBG is negative, the woman requires an annual HbA1C test in line with NICE Public Health Guidance 38 “Prevention of T2DM – risk identification and interventions for individuals at high risk”4 (see above)References 1.
This is a preventable disease and affect nearly 29.1 million people in United States and about 8 million are undiagnosed. In 2012, 1.7 million new cases where diagnosed with type 2 diabetes. Some people who are at higher risk of developing type 2 diabetes are men more than women, excessive weight, family history, non-active, and poor diet individuals. It is said that 1 in 7 children will develop type 2 diabetes in the future if one of their parents have the disease. When discussing ethnic groups type 2 diabetes is more common in Native Americans, African Americans, Hispanics and Asian Americans. Native American adults are found to be at the highest risk of all ethnic groups to be diagnosed. 9.3% of adults of 20 have been diagnosed with types 2 diabetes and 25 percent of adults 65 and older have types 2 diabetes (Type 2 Diabetes Statistics and Facts,
Type II Diabetes Mellitus (DM) is a chronic disease that influences the physical and social aspects of life for millions of people living in New York City (NYC). The excess accumulation of glucose in the blood caused by this disease can lead to the breakdown of many organs in the human body leading to increased hospitalizations and mortality. Although diabetes is a manageable disease given the appropriate care and education, the disease and its complications disproportionately affect African-Americans or non-Hispanic blacks then any other ethnic group in NYC. The NYC Department of Health & Mental Hygiene (DOHMH) reports death rates among black New Yorkers are higher than among whites, regardless of neighborhood income. There is a significant number of non-Hispanic blacks afflicted in low-income neighborhoods due to the environmental injustices such as lack of fresh food options, neighborhood poverty, and limited recreational space for physical activity and exercise. With lifestyle modification as the mainstay of treatment, recognizing the environmental deficiencies and rectifying these problems at the local and federal levels will help to decrease this health disparity.
Diabetes has been established to be more precarious for women, as it can augment pregnancy complications such as macrosomia, miscarriage, and birth defects. Women with diabetes also have a higher prevalence of secondary cardiovascular disease. Among those women who continue in the spiral of diabetes complications, ischemic heart disease is an even greater complication which will reduce survival and quality of life (Beckles and Thompson-Reid, 2011). Pregnant women diagnosed with gestational diabetes mellitus (GDM) have a higher risk of developing type 2 diabetes later in their lifetime. It has been proven that an average of 25 percent of pregnant women with GDM will be diagnosed with type 2 diabetes within an average of seven years (Sokup, Ruszkowska-Ciatec, Walentowicz, Grabiec & Rose, 2014). In such women, blood glucose and triglyceride levels must be monitored closely, and appropriate action and referrals are given if needed for proper disease management.
In women at high risk of developing gestational diabetes, a normal screening test result is followed up with another screening test at 24-28 weeks for confirmation of the diagnosis.
Fasting Plasma Glucose (FPG) - This test checks your blood sugar levels after an 8-hour fast. This means that you should not eat or drink anything but
Between 5.5 and 8.8% of pregnant women develop GDM in Australia. Risk factors for GDM include a family history of diabetes, increasing maternal age, obesity and being a member of a community or ethnic group with a high risk of developing type 2 diabetes. While the carbohydrate intolerance usually returns to normal after the birth, the mother has a significant risk of developing permanent diabetes while the baby is more likely to develop obesity and impaired glucose tolerance and/or diabetes later in life. Self-care and dietary changes are essential in treatment.
A study done by the Health Care Agency found that the most common prenatal complication in women that lived in Orange County was gestational diabetes. The stated target population is women that live in Orange County, specifically in Santa Ana. The prevalence of gestational diabetes in Orange County was 7.1% affecting nearly 3,000 women in 2009 (Ramos et al., 2011, 2). This data shows the prevalence rates according to each city in Orange County Santa Ana as well as Anaheim, Garden Grove, and Irvine made up almost half of the gestational diabetes cases in 2010 (Refowitz, 2012, 8). Looking at Santa Ana specifically, the prevalence of gestational diabetes was 7.06% with a total of 438 cases in 2010 with a total of 6,202. The stated target
Precautions such as an early Oral Glucose Tolerance Test (OGTT) to test for GDM would be recommended by the SAPPG to begin early treatment if GDM is diagnosed, this could reduce other potential risks like fetal macrosomia (SAMNCN 2012b & 2015). If deemed appropriate Kelly could receive routine antenatal care provided by a midwife until complications arise in which care an obstetrician should be consulted (Daemers DOA & et al. 2014).
Diabetes Mellitus is diagnosed using the American diabetes Association ADA criteria(37) (38). The established glucose criteria for the diagnosis of diabetes that include the FPG (>126 mg/dl) and two hour plasma glucose > 200mg/dl during an OGTT is still valid. Additionally, patients with classic symptoms of hyperglycemia or hyperglycemic crisis can be diagnosed when a random plasma glucose is ≥200 mg/dL (11.1 mmol/L). HbA1C, which relects the glycemic status of 2-3 months has been recommended for the diagnosis of DM with a threshold of > 6.5%.
GDM may be diagnosed with a 2-step or 1-step approach glucose screening test that involves drinking a syrupy glucose drink. It is recommended to perform glucose testing between 24 and 28 weeks of gestation (National Guideline Clearinghouse, n.d.). In the initial non-fasting 2-step approach, 50 grams oral glucose tolerance test (OGTT) is given followed by one hour blood glucose measurement (USPSTF, 2013). If the individual’s blood glucose level meet or exceed threshold of 130 to 140 mg/dL, then the individual undergo a fasting 100 grams, three-hour diagnostic OGTT (National Guideline Clearinghouse, n.d.). During the 100 grams OGTT, fasting blood sugar levels are reviewed after 1, 2, and 3 hours (National Guideline Clearinghouse, n.d.). Individuals are considered to have gestational diabetes if two of the blood glucose values are at or above the limit. In the fasting 1-step approach, 75 grams glucose load is given and blood sugar levels are reviewed after one and two hours (National Guideline Clearinghouse, n.d.). The individual is diagnosed with GDM if any of the blood sugar values met or exceeded (1) 92 mg/dL (fasting), (2) 180 mg/dL (one-hour value), or (3) 153 mg/dL (two-hour
Criteria for detecting diabetes has not changedin nearly 50 years, with fasting blood glucose serving as the primary test
GDM is a pregnancy complication which is the result of the mother developing high blood glucose but insufficient insulin (Mayo Clinic Staff, 2016). Preventive measures should be taken to prevent or manage GDM. It is important for health professionals to educate pregnant women about GDM, explaining to them that prevalence of this disease is as high as 9.2% (American Diabetes Association, 2016). The prevalence of GDM in the US has more than doubled; affecting over 200,000 females per year (Ferranti, Venkat Narayan, Reilly, Foster, McCullough, Ziegler, Ying & Dunbar, 2014). In 2012, Diabetes cost the economy $322 billion, consisting of $244 billion in excess medical costs and $78 billion in reduced productivity, with an average case of GDM
Given the multitude of maternal and perinatal complications associated with GDM, primary guidelines emphasize the important of preventing the development of GDM. Weight loss and aerobic exercise prior to becoming pregnant can decrease one’s risk of developing GDM (Garrison, 2015). Women should attempt to continue participating in physical activity throughout pregnancy and prevent excessive gestational weight gain. Furthermore, another critical component in the prevention and treatment of GDM is provider recognition of the vital requirement of screening pregnant females, as well as accurate recommendations as to the timing of screening, and identification of those females who are at high risk for development of GDM.