Diagnostic Criteria

Symptoms of diabetes include: frequent urination (polyuria), hunger, thirst (polydipsia), weight loss, blurred vision, and skin itchiness. In children there may be growth impairment. Among type 2 diabetics insulin resistance may be present for a number of years prior to the development of elevated blood glucose levels. When insulin production can no longer compensate for peripheral tissue resistance, blood glucose levels rise, reaching the criteria for a diagnosis of diabetes.

The World Health Organization (WHO) diagnostic criteria for diabetes mellitus include a medical history of diabetes or a fasting plasma glucose level >140 mg/dl (7.8 mmol/L) or a plasma glucose level 2 hr after a meal of > 200 mg/dl (11.1 mmol/L). However, the National Diabetes Data Group in the United States has a criterion of a fasting plasma glucose level of >126 mg/dl (7.0 mmol/L) (ADA, 2002a; WHO, 1985). An oral glucose tolerance test is also used for diagnosis. If the plasma glucose level is > 200 mg/L (11.1 mmol/L) 2 hr after consuming a standard 75 mg oral glucose load, then a provisional diagnosis of diabetes is made. Normal plasma glucose levels are > 110 mg/L (6.1 mmol/L). Individuals with "pre-diabetes" or impaired glucose tolerance have fasting plasma glucose levels between 110 mg/dl and 126 mg/dl, or an oral glucose tolerance test equal to or exceeding 140 mg/L (7.8 mmol/L).

The 2-hr plasma glucose levels have been set at a cut point where the prevalence of eye disease (retinopathy) and kidney disease (nephropathy) increase dramatically. However, in certain populations (e.g., Pima Indians and Pacific Islanders) with high a prevalence of type 2 diabetes the cut point at which there is a marked increase in complications is lower (< 126 mg/dl). These include the Pima Indians of Arizona and several Pacific Island populations.

The American Diabetes Association (ADA) Expert Committee on the Diagnosis and Classification of Diabetes Mellitus (ADA, 2002a) recommend testing for diabetes for individuals who have the following characteristics: (1) are overweight with a body mass index (BMI) >25 kg/m2); (2) have a first-degree relative with diabetes; (3) are members of high-risk ethnic populations (e.g., African American, Hispanic American, Native American, Asian American, or Pacific Islander); (4) delivered a baby weighing > 9 lb; (5) have ever had gestational diabetes mellitus; (6) are hypertensive (> 140/90 mmHg); (7) have HDL cholesterol > 35 mg/dl (0.90 mmol/L); (8) have triglycerides > 250 mg/dl (2.82 mmol/L); or (9) had impaired glucose tolerance or impaired fasting glucose levels on previous testing.

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