Diabetes mellitus(DM): Symptoms & Diagnosis
Diabetes mellitus is one of the most common diseases in our society. The American Diabetes Association (ADA) recommends that one of the following four tests be used to diagnose DM: glycated hemoglobin (A1C), fasting plasma glucose (FPG), random elevated glucose with symptoms, or abnormal oral glucose Tolerance test. In addition, people with impaired fasting glucose or impaired glucose tolerance are known to have a high rate of progression to DM and should receive periodic diagnostic tests.
Symptoms
Clinical symptoms are known to vary according to the type of DM. In general, DM type II is the most common type of DM occurring in adults (> 90%), which can be expressed by hyperglycemia and insulin resistance. The most typical clinical symptoms are asymptomatic and hyperglycemia. Many patients do not have any special symptoms, but hyperglycemia is often seen in screening tests such as health screenings. Asymptomatic patients have more than 126 mg / dL of fasting plasma glucose (FPG), more than 200 mg / dL of two-hour post oral glucose challenge, and more than 6.5% of A1C. Hyperglycemia is often associated with clinical symptoms, such as polyuria, polydipsia, nocturia, blurred vision, and weight loss. However, these symptoms are non-specific because they are often noticed after diagnosis of DM type II. Polyuria occurs frequently when serum glucose levels are> 180 mg / dL.
The clinical symptoms of DM type I are different from those of type II. DM Type I is a disease in which the B cell of pancreas is destroyed by autoantibody and insulin deficiency occurs. It accounts for 5-10% of adult diabetes. A representative clinical symptom is diabetic ketoacidosis (DKA). Approximately 25% of adult DM type I patients complained of DKA as the first clinical symptom. DM type I in adults showed more hyperglycemia-related symptoms such as polyuria, polydipsia, and fatigue than in children. In addition, 2 to 12% of these patients have clinical symptoms similar to type II, and are called autoimmune-induced diabetes mellitus, latent autoimmune diabetes mellitus (LADA).
Diagnosis
DM can be easily suspected through typical clinical symptoms. The most characteristic clinical symptoms are thirst, polyuria, weight loss, blurry vision, which are mostly associated with hyperglycemia. In addition to these symptoms, DM of more than 200 mg / dL can be diagnosed without further examination.
However, a large number of patients do not exhibit these clinical symptoms. In this case, Fasting plasma glucose (FPG), 75g-two-hour post oral glucose challenge (OGTT) and glycated hemoglobin (A1C) can be used. If FPG is greater than 126 mg / dL, 75 g-OGTT is greater than 200 mg / dL, or A1C is greater than 6.5%, DM can be diagnosed. However, in patients with these non-clinical symptoms, the test must be repeated to confirm the diagnosis. Exceptionally, a re-examination is not necessarily required if both tests (eg FPG and A1C) show the results of DMs [6]. The National Health and Nutrition Examination Survey (NHANES) III Second Examination describes the need for a review by a re-examination.
World Health Organization (WHO) Criteria
According to the WHO criteria, DM can be diagnosed if FPG ≥ 126 mg / dL or two-hour post glucose challenge value ≥ 200 mg / dL or A1C ≥ 6.5%. DM can not be ruled out even if A1C <6.5%. (IGT) <126 mg / dL and two-hour glucose ≥ 140 mg / dL & <200 mg / dL. When the fasting glucose level is between 110 and 120 mg / dL, impaired fasting glucose IFG). Both IGT and IFG belong to the high risk factor of DM.
American Diabetes Association (ACA) Criteria
For ADA, FPG level, 75 g oral glucose tolerance test, and A1C value are recommended. According to ADA criteria, DM is defined as follows.
Normal: FPG <140 mg / dL, two-hour glucose during oral glucose tolerance test (OGTT) <140 mg / dL
(3) A1C between 5.7 and 6.4%. In the present study, we evaluated the effects of intravenous glucose (IGT) and intravenous glucose (IGT)
Diabetes mellitus: 1) FPG ≥ 126 mg / dL, 2) A1C ≥ 6.5%, 3) two-hour value of 75 g OGTT ≥ 200 mg / dL, 4) random plasma glucose ≥ 200 mg / dL
Symptoms
Clinical symptoms are known to vary according to the type of DM. In general, DM type II is the most common type of DM occurring in adults (> 90%), which can be expressed by hyperglycemia and insulin resistance. The most typical clinical symptoms are asymptomatic and hyperglycemia. Many patients do not have any special symptoms, but hyperglycemia is often seen in screening tests such as health screenings. Asymptomatic patients have more than 126 mg / dL of fasting plasma glucose (FPG), more than 200 mg / dL of two-hour post oral glucose challenge, and more than 6.5% of A1C. Hyperglycemia is often associated with clinical symptoms, such as polyuria, polydipsia, nocturia, blurred vision, and weight loss. However, these symptoms are non-specific because they are often noticed after diagnosis of DM type II. Polyuria occurs frequently when serum glucose levels are> 180 mg / dL.
The clinical symptoms of DM type I are different from those of type II. DM Type I is a disease in which the B cell of pancreas is destroyed by autoantibody and insulin deficiency occurs. It accounts for 5-10% of adult diabetes. A representative clinical symptom is diabetic ketoacidosis (DKA). Approximately 25% of adult DM type I patients complained of DKA as the first clinical symptom. DM type I in adults showed more hyperglycemia-related symptoms such as polyuria, polydipsia, and fatigue than in children. In addition, 2 to 12% of these patients have clinical symptoms similar to type II, and are called autoimmune-induced diabetes mellitus, latent autoimmune diabetes mellitus (LADA).
Diagnosis
DM can be easily suspected through typical clinical symptoms. The most characteristic clinical symptoms are thirst, polyuria, weight loss, blurry vision, which are mostly associated with hyperglycemia. In addition to these symptoms, DM of more than 200 mg / dL can be diagnosed without further examination.
However, a large number of patients do not exhibit these clinical symptoms. In this case, Fasting plasma glucose (FPG), 75g-two-hour post oral glucose challenge (OGTT) and glycated hemoglobin (A1C) can be used. If FPG is greater than 126 mg / dL, 75 g-OGTT is greater than 200 mg / dL, or A1C is greater than 6.5%, DM can be diagnosed. However, in patients with these non-clinical symptoms, the test must be repeated to confirm the diagnosis. Exceptionally, a re-examination is not necessarily required if both tests (eg FPG and A1C) show the results of DMs [6]. The National Health and Nutrition Examination Survey (NHANES) III Second Examination describes the need for a review by a re-examination.
World Health Organization (WHO) Criteria
According to the WHO criteria, DM can be diagnosed if FPG ≥ 126 mg / dL or two-hour post glucose challenge value ≥ 200 mg / dL or A1C ≥ 6.5%. DM can not be ruled out even if A1C <6.5%. (IGT) <126 mg / dL and two-hour glucose ≥ 140 mg / dL & <200 mg / dL. When the fasting glucose level is between 110 and 120 mg / dL, impaired fasting glucose IFG). Both IGT and IFG belong to the high risk factor of DM.
American Diabetes Association (ACA) Criteria
For ADA, FPG level, 75 g oral glucose tolerance test, and A1C value are recommended. According to ADA criteria, DM is defined as follows.
Normal: FPG <140 mg / dL, two-hour glucose during oral glucose tolerance test (OGTT) <140 mg / dL
(3) A1C between 5.7 and 6.4%. In the present study, we evaluated the effects of intravenous glucose (IGT) and intravenous glucose (IGT)
Diabetes mellitus: 1) FPG ≥ 126 mg / dL, 2) A1C ≥ 6.5%, 3) two-hour value of 75 g OGTT ≥ 200 mg / dL, 4) random plasma glucose ≥ 200 mg / dL
