Following is
from
the section entitled
"Detection"
from the document "Diabetes: A National
Plan for Action", written in December 2004.
The Importance of Early Diabetes Detection
Approximately 5 million of the 18 million people with diabetes in the U.S. do not know
they have it.(56) Early detection and treatment of diabetes is an important step toward keeping
people with diabetes healthy. It can help to reduce the risk of serious complications such as
premature heart disease and stroke, blindness, limb amputations, and kidney failure.(57)
Some of the important signs and symptoms of diabetes are shown in Table 2. Many
people with
type 2 diabetes
have no signs or symptoms, but do have risk factors (see Table 1).
For persons at increased risk or those experiencing these signs and symptoms, several tests are
used to diagnose diabetes:
?? A fasting plasma glucose test measures blood glucose after not eating for at least 8
hours. This test is used to detect diabetes (126 mg/dl and above) or pre-diabetes
(between 100 mg/dl and 125 mg/dl).58
?? An oral glucose tolerance test measures blood glucose after not eating for at least 8
hours and 2 hours after drinking a glucose-containing beverage. This test is used to
diagnose diabetes (200 mg/dl and above) or pre-diabetes (between 140 mg/dl and
199 mg/dl).59
?? In a random plasma glucose test, blood glucose is checked without regard to when
food is consumed. Values of 200 mg/dl or greater in the presence of specific
symptoms, such as increased urination or thirst and unexplained weight loss, indicate
a diagnosis of diabetes.(60)
Positive test results should be confirmed by repeating the fasting plasma glucose test or the oral
glucose tolerance test on a different day.
Type 1 diabetes is typically detected much sooner after onset than type 2 disease because
the symptoms are dramatic and the need for medical care is immediate and obvious. In contrast,
the signs and symptoms of type 2 diabetes can be absent or so mild that the disease may not be
diagnosed for 7 to 10 years after the onset resulting in increased risk for complications, such as
nerve, eye, and kidney disease, when the disease is finally detected.(61)
Table 2. Signs and Symptoms of Diabetes
| Symptoms |
Type 1 Diabetes |
Type 2 Diabetes |
| Frequent urination |
X |
X |
| Unusual thirst |
X |
X |
| Extreme hunger |
X |
X |
| Unusual weight loss |
X |
|
| Extreme fatigue |
X |
X |
| Sudden vision changes |
X |
X |
| Fruity, sweet, or wine-like odor on breath |
X |
|
| Heavy, labored breathing |
X |
|
| Stupor, unconsciousness |
X |
|
| Irritability |
X |
X |
| Frequent infections |
X |
X |
| Blurred vision |
X |
X |
| Cuts/bruises that are slow to heal |
X |
X |
| Recurring skin, gum, or bladder infections |
|
X |
SOURCES: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). (2004). Am I at risk for type 2
diabetes? NIH Publication No. 04-4805. Available at http://diabetes.niddk.nih.gov/dm/pubs/riskfortype2/. Accessed May
28, 2004.
Juvenile Diabetes Research Foundation. Knowing the warning signs for type 1 diabetes could save a child's life. Available at
http://www.jdrf.org/index.cfm?fuseaction=home.viewPageandpage_id=117E31FB-001E-A85D-3C71EBB8B19732AC.
Accessed May 28, 2004.
In the past, type 2 diabetes was a disease seen primarily in adults over age 45 with the
highest percentage occurring in adults 60 years and older.(62) It is now being seen at increasingly
younger ages, including children and adolescents.(63) As with adults, identifying type 2 diabetes in
children is challenging because children may not have any symptoms or show only very mild
symptoms. Diagnosis of type 2 diabetes in young people means that they may have the disease
for a longer period time than if they developed diabetes as adults. The longer duration of the
disease increases the rate of severe complications such as blindness, renal failure, and
amputations.(64)
Early diagnosis of diabetes and pre-diabetes is important so that patients can begin to
manage the disease early and potentially prevent or delay the serious disease complications that
can decrease quality of life. Recognizing the importance of identifying the more than 5 million
Americans with undiagnosed diabetes, Secretary Tommy G. Thompson launched the Diabetes
Detection Initiative (DDI) in November 2003. The DDI is a new community-based effort to
identify persons with undiagnosed type 2 diabetes and refer them for follow-up blood testing and
treatment, if appropriate. The pilot program was evaluated in 10 locations throughout the U.S.
(see Appendix C for more information on the DDI).
Action Steps for Detection
Knowledge of the risk factors, and signs and symptoms of diabetes and pre-diabetes may
help increase awareness about the need to be tested for diabetes. Individuals, family members,
friends, health care providers, schools, the media, community organizations, health insurance
providers, employers, as well as local, state, and federal governments all play important roles in
helping to ensure that at-risk or asymptomatic individuals are screened for diabetes.(65)
56) Williamson DF, Vinicor F, Bowman BA. (2004). Centers For Disease Control and Prevention Primary
Prevention Working Group: Primary prevention of type 2 diabetes mellitus by lifestyle intervention: implications
for health policy. Ann Int Med, 140(11), 951-957.
57) U.S. Department of Health and Human Services (DHHS). Diabetes detection initiative: Finding the undiagnosed.
Available at: http://www.ndep.nih.gov/ddi/about/index.htm.
58) National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). (2003). Diagnosis of diabetes. NIH
Pub No. 04-4642. Available at: http://diabetes.niddk.nih.gov/dm/pubs/diagnosis/index.htm.
59) ibid.
60) ibid.
61) DHHS, op.cit.
62 ibid.
63) Centers for Disease Control and Prevention (CDC). (2000). CDC funds registries for childhood diabetes. Press
release, November 21. Available at http://www.cdc.gov/od/oc/media/pressrel/r2k1226.htm
64) ibid.
65) The USPSTF concludes that the evidence is insufficient to recommend for or against routinely screening
asymptomatic adults for type 2 diabetes, impaired glucose tolerance, or impaired fasting glucose. The USPSTF
does recommend screening for type 2 diabetes in adults with hypertension or hyperlipidemia (see
http://www.ahrq.gov/clinic/uspstf/uspsdiab.htm. for more information). The generally accepted standards of care
for diabetes screening can be found at: http://care.diabetesjournals.org/cgi/content/full/27/suppl_1/s11#SEC3
From the NDEP
Dec2004
http://aspe.hhs.gov/health/NDAP/NDAP04.pdf
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