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Diabetes Mellitus Type 2

Discussion

Diagnostic Criteria

In 1997, the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus published a new classification scheme and revised diagnostic criteria for diabetes mellitus (the following criteria are from the 2011 revision).

Classification of Diabetes Mellitus

Diagnostic elements: genetic markers; autoantibodies, clinical characteristics (ketosis, pattern of progression, obesity, age and treatment response)

Type 1: Beta-cell destruction usually leading to absolute insulin deficiency
Type 2: Insulin resistance with insulin secretion deficiency. 90 - 95% of people who have diabetes have Type 2.
Other specific types:

Genetic defects in beta-cell function
Genetic defects in insulin action
Exocrine pancreas diseases
Endocrinopathies
Drug or chemical induced
Infections
Other rare forms

Gestational: Insulin resistance with beta-cell dysfunction

Diagnosis of Diabetes Mellitus

(Any finding falling within a positive criteria should be repeated on a subsequent day with another test in any criteria set: e.g., a random plasma glucose with symptoms, might be followed-up with a fasting plasma glucose.)

Fasting plasma glucose (FPG) ≥ 126 mg/dl (7.0 mmol/l) OR
Symptoms (such as polyuria, polydipsia, unexplained weight loss) AND
a casual plasma glucose ≥ 200 mg/dl (11.1 mmol/l) OR
Plasma glucose ≥ 200 mg/dl ( 11.1 mmol/l) 2 hours after a 75g glucose load OR
A1C ≥ 6.5%.

"The Expert Committee . . . recognized an intermediate group of individuals whose glucose levels do not meet criteria for diabetes, yet are higher than those considered normal."

Impaired fasting glucose (IFG) (fasting plasma glucose (FPG) levels): 100 - 125mg/dl (5.6 - 6.9mmol/l); OR
Impaired glucose tolerance (IGT) (2-h values in the oral glucose tolerance test (OGTT)): 140 mg/dl - 199 mg/dl (7.8 - 11.0 mmol/l); OR
A1C: 5.7 - 6.4%.

Gestational Diabetes Mellitus (GDM)

Screen at 24-28 weeks
75g OGTT: fasting: ≥ 92mg/dl (5.1 mmol/l) ; OR
1 hr: ≥ 180mg/dl (10.0 mmol/l); OR
2 hr: ≥ 153mg/dl (8.5 mmol/l).