Diabetes mellitus is diagnosed and characterized by chronic hyperglycemia. The effects of

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1 Focused Issue of This Month Early Diagnosis of Diabetes Mellitus Hyun Shik Son, MD Department of Internal Medicine, The Catholic University of Korea College of Medicine E - mail : sonhys@gmail.com J Korean Med Assoc 2008; 51(9): Diabetes mellitus is diagnosed and characterized by chronic hyperglycemia. The effects of diabetes mellitus include long- term damage, dysfunction, and failure of various organs, especially the eyes, kidneys, heart, and blood vessels. Often diabetic symptoms are not severe or may even be absent. Hyperglycemia sufficient to cause pathologic functional changes may quite often be present for a long time before the diagnosis is made. Because diabetes mellitus is a chronic progressive disease, early diagnosis of diabetes is important to prevent chronic diabetic complications, especially in high risk subjects. In most countries, screening methods for the early diagnosis of diabetes have not yet been agreed. The fasting plasma glucose is simple, quick, acceptable to patients, and of low cost, but can miss those with isolated post-challenge hyperglycemia. The ogtt is difficult to perform, impractical for large numbers, and expensive, but is the only way to identify post-load hyperglycemia. Attention is focused on those at high risk of developing diabetes. Keywords: Diabetes mellitus; Early diagnosis Abstract 813

2 Son HS Table 1. Criteria for the diagnosis of diabetes mellitus 1. Symptoms of diabetes plus random blood glucose concentration 11.1mmol/L (200mg/dL) or Random is defined as without regard to time since the last meal. Classic symptoms of diabetes include polyuria, polydipsia, and weight loss. 2. Fasting plasma glucose 7.0mmol/L (126mg/dL) or Fasting is defined as no caloric intake for at least 8 h. 3. Two-hour plasma glucose 11.1mmol/L (200mg/dL) during an oral glucose tolerance test The test should be performed using a glucose load containing the equivalent of 75g anhydrous glucose dissolved in water; not recommended for routine clinical use. Note: In the absence of unequivocal hyperglycemia and acute metabolic decompensation, these criteria should be confirmed by repeat testing on a different day. Source: Adopted from American Diabetes Association,

3 Early Diagnosis of DM Table 2. Risk factors for type 2 diabetes mellitus Family history of diabetes (i.e., parent or sibling with type 2 diabetes) Obesity (BMI 25kg/m 2 ) Habitual physical inactivity Race/ethnicity (e.g., African American, Latino, Native American, Asian American, Pacific Islander) Previously identified IFG or IGT History of GDM or delivery of baby 4kg (> 9 Ib) Hypertension (blood pressure 140/90mmHg) HDL cholesterol level 35mg/dL (0.90mmol/L) and/or a triglyceride level 250mg/dL (2.82mmol/L) Polycystic ovary syndrome or acanthosis nigricans History of vascular disease Note: BMI, body mass index; IFG, impaired fasting glucose; IGT, impaired glucose tolerance; GDM, gestational diabetes mellitus; HDL, high-density lipoprotein Source: Adopted from American Diabetes Association,

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