Glucose Tolerance Test Diabetes Mellitus

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Glucose Tolerance TestDiabetes Mellitus

• Dr. David Gee
• FCSN 442 - Nutrition Assessment Laboratory

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Prevalence2006

• 20.8 million Americans
• 7 population
• 9.6 adults over 20 years
• 21 adults over 60 years
• 30 undiagnosed
• 6.2 million undiagnosed
• 41 million with pre-diabetes

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Implications of the Diabetes Control and
Complications Trial Diabetes Care 25S25-S27,
2002

• Conventional Treatment vs Intensive Treatment
• IT had lower HA1C and FBG
• Average 7 year follow up
• Measured outcomes
• Retinopathy, nephropathy, neuropathy
• Results
• 60 reduction in risk in intensive treatment group

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Report of the Expert Committee on the Diagnosis
and Classification ofDiabetes Mellitus

• Diabetes Care 28S4-S36, 2005
• See at
• Diabetes.org
• For health professionals
• 2005 clinical practice recommendations

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Criteria for testing for DM in assymptomatic,
undiagnosed patients

• gt 45 yrs, every 3 yrs (if normal)
• lt 45 yrs, every 3 yrs if
• BMI gt 25 and any of the following
• 1st degree relative with DM
• Blacks, Hispanic, Native American, Asian American
• Habitually inactive
• Hx Gestational Diabetes or baby gt 9 lbs
• History of vascular disease

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Criteria for testing for DM in assymptomatic,
undiagnosed patients

• lt 45 yrs, every 3 yrs if (cont.)
• Hypertension (gt140/90)
• HDL lt 35 mg/dl
• TG gt 250 mg/dl
• previous Dx of impaired glucose tolerance or
  impaired fasting glucose

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Testing of children for Type 2 Diabetes

• Criteria
• Overweight (BMI gt85th percentile for age and sex,
  weight for height gt85th percentile, or weight
  gt120 of ideal for height)
• Plus any two of the following risk factors
• Family history of Type 2 DM, 1o or 2o
• Native American, black, asian, latino
• Signs of insulin resistance (acanthosis
  nigricans, hypertension, dyslipidemia)
• Age of initiation 10 yrs or onset of puberty
• Frequency every two years
• Test FBG test preferred

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Acanthosis nigricans
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Fasting Blood Glucose

• gt 8 hr fast
• DM if FBG gt 126 mg/dl (7.0mM)
• on 2 occasions
• Pre-Diabetes
• Impaired fasting glucose (IFG)
• if 110 - 125 mg/dl

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Casual Plasma Glucose

• Casual is defined as any time of day without
  regard to time since last meal
• gt 200 mg/dl (11.1mM) plus
• Symptoms of diabetes
• Polyuria, polydipsea, unexplained weight loss
• Confirm on subsequent visit with fasting blood
  glucose or oral glucose tolerance test

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Glucose Tolerance Testing

• for
• adults with impaired FBG
• during pregnancy if at risk
• Procedure
• Following 8 hour fast
• Glucose dose 1.75g/kg IBW
• Maximum 75 g dose (BWlt43kg, 94lbs)
• 25 g/dl glucose test solution
• Test at 2 hours

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Diagnostic Criteria

• DM if glu gt 200 mg/dl at 2 hours
• IGT if glu gt140 - 199 at 2 hours
• normal if glu lt 140 mg/dl
• IGT and IFT recently termed pre-diabetic

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Hemoglobin A1cglycated hemoglobin

• Average lifespan of red blood cells
• 120 days (4 months)
• Glycosylation of blood proteins in proportion to
  blood glucose concentration
• Normal 5
• Goal for diabetics lt 7

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