DIABETES

The new guidelines issued by the American Diabetes Association changed the definition of diabetes into: Anyone with fasting glucose > 125 mg/dL now qualifies as diabetic (the old threshold was 140) – and any reading over 100 mg/dL is considered impaired glucose tolerance.

PREDICTION OF DIABETES

Type 1 Diabetes mellitus (lDDM) is a chronic progressive autoimmune disease. It is now possible to predict (lDDM) in individuals before the onset of clinical manifestations. In fact testing can begin as early as 1 - 2 years of age.

The criteria for prediction include:

1) Positive family history of diabetes

2) HLA typing

More than 90% of (lDDM) patients are DR4-DQ8 or DR3 - DQ2 or both.

3) Presence of more than one Autoantibody

Namely; anti insulin, ICA (islet cell antibody) or anti GAD (glutamic acid decarboxylase). Anti insulin is usually the first to appear in children, while anti GAD is the first to appear in adults.

Screening for prediction of type 1 diabetes in children and adults is now recommended with the aim of halting or delaying onset of the disease and its complications.

If the screening tests are positive, nonimmune therapy is now suggested in the form of nicotinamide, antioxidants and small doses of insulin under supervision of the clinician.

MONITORING & FOLLOW UP OF DIABETIC PATIENTS

Monthly     F      Blood & Urine glucose + Fructosamine

3 Months   F      Glycosylated Hemoglobin + Microalbuminuria

Yearly        F      Liver & Kindly functions + Lipid profile

FRUCTOSAMINE:

Fructosamine is formed by glucose linkage to albumin or other proteins. It has the advantage over (HBA1C) of having a shorter half life hence is more useful in monitoring over a one month period.

GLYCOSYLATED HEMOGLOBIN (HbA1C):

HbA1C is formed by addition of a glucose molecule to the beta chain of hemoglobin. This process is formed progressively and irreversibly inside the red cells and is directly dependent on the blood glucose concentration.

HbA1C is probably the best single measure for monitoring diabetes over a three months period especially if the physician plans to alter therapy.

However this test does not give information about same day variations in blood glucose.

MICROALBUMINURIA:

Microalbuminuria is the key parameter in marking the onset of clinical diabetic or hypertensive nephropathy. Strict glycaemic control and normalization of blood pressure can reverse microalbuminuria.

LIPID PROFILE:

Hyperlipidemia is suggested if:

Triglycerides                 > 185 mg%

Total Cholesterol         > 200 mg%

The risk of cardiac and vascular complications is increased if:

HDL Cholesterol          < 35   mg%

LDL Cholesterol          > 160 mg%

All patients who perform these tests should be fasting for 12-14hours.