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This book provides a scientific rationale on managing pregnancies complicated by diabetes and offers recommendations on which clinical practice can be.
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Tubes with only enolase inhibitors, such as sodium fluoride, should not be relied on to prevent glycolysis. To avoid misclassification of patients, the goal for glucose analysis should be to minimize total analytical error, and methods should be without measurable bias. There are insufficient published data to support a role for portable meters and skin-prick finger-stick blood samples in the diagnosis of diabetes or for population screening. The imprecision of the results, coupled with the substantial differences among meters, precludes the use of glucose meters from the diagnosis of diabetes and limits their usefulness in screening for diabetes.

A moderate. SMBG is recommended for all insulin-treated patients with diabetes. In patients with type 2 diabetes treated with diet and oral agents, SMBG may help achieve better control, particularly when therapy is initiated or changed. Data are insufficient, however, to claim an associated improvement of health outcomes. The role of SMBG in patients with stable type 2 diabetes controlled by diet alone is not known. C high. Patients should be instructed in the correct use of glucose meters, including quality control. Comparison between SMBG and concurrent laboratory glucose analysis should be performed at regular intervals to evaluate the performance of the meters in the patient's hands.

Multiple performance goals for portable glucose meters have been proposed. These targets vary widely and are highly controversial. Lower total error would be desirable and may prove necessary in tight glucose-control protocols and for avoiding hypoglycemia in all settings. C low. Meters should measure and report plasma glucose concentrations to facilitate comparison with assays performed in accredited laboratories.

Studies are needed to determine the analytical goals quality specifications for glucose meters in SMBG and in intensive care units. Recommendations for future research: Important end-points in studies of SMBG should include, at a minimum, hemoglobin A 1c Hb A 1c and frequency of hypoglycemic episodes to ascertain whether improved meters enable patients to achieve better glucose control.

For studies of meter use in intensive or critical care, important end points include mean blood glucose, frequency of hypoglycemia and variation of glucose control. Ideally, outcomes e. Although the evidence for lowering Hb A 1c is not as strong for children, teens, and younger adults, real-time CGM may be helpful in these groups. Success correlates with adherence to ongoing use of the device.

Patients require extensive training in using the device. Available devices must be calibrated with SMBG readings, and the latter are recommended for making treatment changes. No noninvasive sensing technology is currently approved for clinical glucose measurements of any kind. Major technological hurdles must be overcome before noninvasive sensing technology will be sufficiently reliable to replace existing portable meters, implantable biosensors, or minimally invasive technologies.

C very low. All pregnant women not previously known to have diabetes should undergo testing for gestational diabetes mellitus GDM at 24—28 weeks of gestation. Semiquantitative urine glucose testing is not recommended for routine care of patients with diabetes mellitus. Urine ketone measurements should not be used to diagnose or monitor the course of DKA. Blood ketone determinations that rely on the nitroprusside reaction should be used only as an adjunct to diagnose DKA and should not be used to monitor DKA treatment.

Hb A 1c should be measured routinely in all patients with diabetes mellitus to document their degree of glycemic control. Laboratories should be aware of potential interferences, including hemoglobinopathies, that may affect Hb A 1c test results, depending on the method used. In selecting assay methods, laboratories should consider the potential for interferences in their particular patient population.

In addition, disorders that affect erythrocyte turnover may cause spurious results, regardless of the method used. At least 2 control materials with different mean values should be analyzed as an independent measure of assay performance. Hb A 1c values that are inconsistent with the clinical presentation should be investigated further.

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Somewhat higher intervals are recommended for children and adolescents and may be appropriate for patients with limited life expectancy, extensive comorbid illnesses, a history of severe hypoglycemia, or advanced complications note that these values are applicable only if the NGSP has certified the assay method as traceable to the DCCT reference. Hb A 1c testing should be performed at least biannually in all patients and quarterly for patients whose therapy has changed or who are not meeting treatment goals.

An NGSP-certified method should be performed in an accredited laboratory. Analogous to its use in the management of diabetes, factors that interfere with or adversely affect the Hb A 1c assay will preclude its use in diagnosis.

Point-of-care Hb A 1c assays are not sufficiently accurate to use for the diagnosis of diabetes. Routine measurement of genetic markers is not of value at this time for the diagnosis or management of patients with type 1 diabetes.

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For selected diabetic syndromes, including neonatal diabetes, valuable information can be obtained with definition of diabetes-associated mutations. There is no role for routine genetic testing in patients with type 2 diabetes. These studies should be confined to the research setting and evaluation of specific syndromes. Islet cell autoantibodies are recommended for screening nondiabetic family members who wish to donate part of their pancreas for transplantation into a relative with end-stage type 1 diabetes.

Islet cell autoantibodies are not recommended for routine diagnosis of diabetes, but standardized islet cell autoantibody tests may be used for classification of diabetes in adults and in prospective studies of children at genetic risk for type 1 diabetes after HLA typing at birth. Screening patients with type 2 diabetes for islet cell autoantibodies is not recommended at present.

Standardized islet cell autoantibodies are tested in prospective clinical studies of type 2 diabetes patients to identify possible mechanisms of secondary failures of treatment of type 2 diabetes. Screening for islet cell autoantibodies in relatives of patients with type 1 diabetes or in persons from the general population is not recommended at present.

Standardized islet cell autoantibodies are tested in prospective clinical studies.

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There is currently no role for measurement of islet cell autoantibodies in the monitoring of patients in clinical practice. Islet cell autoantibodies are measured in research protocols and in some clinical trials as surrogate end points. It is important that islet cell autoantibodies be measured only in an accredited laboratory with an established quality-control program and participation in a proficiency-testing program. Annual testing for albuminuria in patients without clinical proteinuria should begin in pubertal or postpubertal individuals 5 years after diagnosis of type 1 diabetes and at the time of diagnosis of type 2 diabetes, regardless of treatment.

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Positive results must be confirmed by analysis in an accredited laboratory. Currently available dipstick tests do not have adequate analytical sensitivity to detect albuminuria. Acceptable samples to test for increased urinary albumin excretion are timed collections e. The optimal time for spot urine collection is the early morning. All collections should be at the same time of day to minimize variation. The patient should not have ingested food within the preceding 2 h, but should be well hydrated i.

Low urine albumin concentrations i. There is no role for routine testing for insulin, C-peptide, or proinsulin in most patients with diabetes. Differentiation between type 1 and type 2 diabetes may be made in most cases on the basis of the clinical presentation and the subsequent course. These assays are useful primarily for research purposes. Occasionally, C-peptide measurements may help distinguish type 1 from type 2 diabetes in ambiguous cases, such as patients who have a type 2 phenotype but present in ketoacidosis.

There is no role for measurement of insulin concentration in the assessment of cardiometabolic risk, because knowledge of this value does not alter the management of these patients. Because current measures of insulin are poorly harmonized, a standardized insulin assay should be developed to encourage the development of measures of insulin sensitivity that will be practical for clinical care. There is no published evidence to support the use of insulin antibody testing for routine care of patients with diabetes. Author Contributions: All authors confirmed they have contributed to the intellectual content of this paper and have met the following 3 requirements: a significant contributions to the conception and design, acquisition of data, or analysis and interpretation of data; b drafting or revising the article for intellectual content; and c final approval of the published article.

Potential conflicts of interest:. Employment or Leadership: D. Consultant or Advisory Role: G. Research Funding: M. Other Remuneration: A. Horvath, Diagon Ltd. Role of Sponsor: The funding organizations played no role in the design of the study. Skip to main content. Research Article Preamble. David B. Sacks , Mark Arnold , George L. Bakris , David E. Bruns , Andrea Rita Horvath , M. Metzger , David M.

IDF Diabetes Atlas 9th Edition 12222

DOI: View this table: View inline View popup. Table 1. Rating scale for the quality of evidence. Table 2. Grading the strength of recommendations. Recommendations Capital letters denote the grade of recommendations, and categories in brackets refer to the quality of the underlying body of evidence supporting each recommendation. A high When glucose is used for screening of high-risk individuals, it should be measured in venous plasma.

B moderate Plasma glucose should be measured in an accredited laboratory when used for diagnosis of or screening for diabetes. GPP good practice point Outcome studies are needed to determine the effectiveness of screening. C moderate Routine measurement of plasma glucose concentrations in an accredited laboratory is not recommended as the primary means of monitoring or evaluating therapy in individuals with diabetes. B low Blood for fasting plasma glucose analysis should be drawn in the morning after the individual has fasted overnight at least 8 h.

B low To minimize glycolysis, one should place the sample tube immediately in an ice—water slurry, and plasma should be separated from the cells within 30 min. C moderate The imprecision of the results, coupled with the substantial differences among meters, precludes the use of glucose meters from the diagnosis of diabetes and limits their usefulness in screening for diabetes.