Fast Five Quiz: Type 2 Diabetes Key Aspects

Romesh Khardori, MD, PhD

Disclosures

January 21, 2022

According to the American Diabetes Association (ADA), screening for prediabetes and T2D with an informal assessment of risk factors or validated tools should be considered in asymptomatic adults. The ADA recommends that T2D testing should be considered in overweight or obese adults who have risk factors, including high-density lipoprotein cholesterol level greater than 35 mg/dL (0.90 mmol/L) and/or a triglyceride level greater than 250 mg/dL (2.82 mmol/L). Screening should also be considered for patients with one or more of these risk factors:

The diagnosis of diabetes should be readily considered when a patient presents with classic symptoms of the disease (ie, polyuria, polydipsia, polyphagia, weight loss). Other symptoms that may suggest hyperglycemia include blurred vision, lower-extremity paresthesias, or yeast infections, particularly balanitis in men. However, many patients with T2D are asymptomatic, and their disease remains undiagnosed for many years.

The "dawn phenomenon" refers to hyperglycemia that occurs in the early morning hours and differs from the Somogyi effect in that it is not preceded by hypoglycemia. The prevalence is estimated to exceed 50% in both T1D and T2D.

ADA recommends universal screening for prediabetes and diabetes using blood tests for all adults 45 years or older, regardless of risk factor.

Updated recommendations from the US Preventive Services Task Force state that nonpregnant adults 35-70 years of age who have overweight or obesity (defined as a body mass index [BMI] greater than or equal to 25 and 30, respectively) should be screened for T2D. The task force also recommends that clinicians consider screening certain individuals at an earlier age, specifically individuals from populations with disproportionately high incidence and prevalence of T2D (eg, American Indian/Alaskan Native, Asian American, Black, Hispanic/Latinx, or Native Hawaiian/Pacific Islander persons) or persons who have a family history of diabetes, a history of gestational diabetes, or a history of PCOS. Screening at a lower BMI (23 or greater) and an earlier age in Asian Americans is also suggested. This calculator for diabetes risk score may aid clinicians in selecting patients for screening.

Learn more about the presentation of T2D.

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