Download Free Medical Definition Diagnosis and Classification of Diabetes Prediabetes Metabolic Syndrome PowerPoint Presentation

Definition Diagnosis and Classification of Diabetes Prediabetes Metabolic Syndrome PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Definition, Diagnosis & Classification of Diabetes, Prediabetes, Metabolic Syndrome" by Zubin Punthakee MD MSc FRCPC, Ronald Goldenberg MD FRCPC FACE, and Pamela Katz MD FRCPC.

This medical PowerPoint presentation talks about Diabetes, prediabetes, and metabolic syndrome, all related to the way the body processes glucose (sugar) from food.

Diabetes: Diabetes is a chronic condition in which the body is unable to properly regulate blood sugar levels. There are two types of diabetes: type 1 and type 2. Type 1 diabetes is an autoimmune disease in which the bodys immune system attacks the insulin-producing cells in the pancreas, while type 2 diabetes is a condition in which the body becomes resistant to insulin, leading to high blood sugar levels.

Prediabetes: Prediabetes is a condition in which blood sugar levels are higher than normal but not yet high enough to be diagnosed as diabetes. People with prediabetes are at increased risk of developing type 2 diabetes, as well as other health problems such as heart disease and stroke.

Metabolic syndrome: Metabolic syndrome is a cluster of conditions that occur together, including high blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol levels. Having metabolic syndrome increases the risk of developing heart disease, stroke, and type 2 diabetes.

All three conditions can be managed and, in some cases, prevented through lifestyle changes such as healthy eating, regular exercise, and maintaining a healthy weight. People with diabetes may also need to take medications and monitor their blood sugar levels to keep their condition under control.

Tags : Diabetes, Prediabetes, Metabolic Syndrome, endocrinology, endocrinology PowerPoint presentation

Published on : Apr 18, 2023 | Views : 1710 | Downloads : 0

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Slide 1-

Definition, Diagnosis & Classification of Diabetes, Prediabetes, Metabolic Syndrome Chapter 3 Zubin Punthakee MD MSc FRCPC, Ronald Goldenberg MD FRCPC FACE, Pamela Katz MD FRCPC 2018 Clinical Practice Guidelines
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Disclaimer All Content contained on this slide deck is the property of Diabetes Canada, its content suppliers or its licensors as the case may be, and is protected by Canadian and international copyright, trademark, and other applicable laws. Diabetes Canada grants personal, limited, revocable, non-transferable and non-exclusive license to access and read content in this slide deck for personal, non-commercial and not-for-profit use only. The slide deck is made available for lawful, personal use only and not for commercial use. The unauthorized reproduction, distribution of this copyrighted work is not permitted. For permission to use this slide deck for commercial or any use other than personal, please contact guidelines@diabetes.ca
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Key Changes No change in the diagnostic criteria New information on methods to differentiate between type 1, type 2 and monogenic diabetes in clinical practice 2018 2018 Diabetes Canada CPG – Chapter 3. Definition, Diagnosis & Classification of Diabetes, Prediabetes, Metabolic Syndrome
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Classification of Diabetes 2018 Diabetes Canada CPG – Chapter 3. Definition, Diagnosis & Classification of Diabetes, Prediabetes, Metabolic Syndrome
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*Neonatal diabetes is a form of diabetes with onset <6 months of age, requires genetic testing, and may be amenable to therapy with oral sulfonylurea in place of insulin therapy 2018 Diabetes Canada CPG – Chapter 3. Definition, Diagnosis & Classification of Diabetes, Prediabetes, Metabolic Syndrome 2018
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Diagnosis of Diabetes FPG ≥7.0 mmol/L Fasting = no caloric intake for at least 8 hours or A1C ≥6.5% (in adults) Using a standardized, validated assay in the absence of factors that affect the accuracy of the A1C and not for suspected type 1 diabetes or 2hPG in a 75 g OGTT ≥11.1 mmol/L or Random PG ≥11.1 mmol/L Random = any time of the day, without regard to the interval since the last meal 2018 Diabetes Canada CPG – Chapter 3. Definition, Diagnosis & Classification of Diabetes, Prediabetes, Metabolic Syndrome A1C, glycated hemoglobin; FPG, fasting plasma glucose; PG, plasma glucose
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Pima Indians Egyptians NHANES III Glycemia and Retinopathy Thresholds The International Expert Committee. Diabetes Care 2009; 32:1327-1334. Threshold levels for the development of retinopathy are similar in all 3 populations: FPG ≥7.0 mmol/L 2hPG ≥11.1 mmol/L A1C ≥6.5% FPG 2hPG HbA1c 70- 89- 93- 97- 100- 105- 116- 109- 136- 226- 364- 244- 185- 156- 138- 126- 116- 106- 94- 38- 3.4- 4.8- 5.0- 5.2- 5.3- 5.5- 5.7- 6.0- 6.7- HbA1c (%) 2hPG (mg/dl) FPG (mg/dl) Retinopathy (%) 9.5- 15 10 5 0 FPG 2hPG HbA1c 57- 79- 84- 89- 93- 99- 130- 108- 178- 258- 386- 304- 218- 155- 125- 110- 99- 90- 80- 39- 2.2- 4.7- 4.9- 5.1- 5.4- 5.6- 6.0- 6.9- 8.5- HbA1c (%) 2hPG (mg/dl) FPG (mg/dl) Retinopathy (%) 10.3- 50 20 10 0 40 30 FPG 2hPG HbA1c 42- 87- 90- 93- 96- 98- 104- 101- 109- 120- 195- 154- 133- 120- 112- 102- 94- 86- 75- 34- 3.3- 4.9- 5.1- 5.2- 5.4- 5.5- 5.6- 5.7- 5.9- HbA1c (%) 2hPG (mg/dl) FPG (mg/dl) Retinopathy (%) 6.2- 15 10 5 0 2018 Diabetes Canada CPG – Chapter 3. Definition, Diagnosis & Classification of Diabetes, Prediabetes, Metabolic Syndrome A1C, glycated hemoglobin; FPG, fasting plasma glucose; PG, plasma glucose
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DETECT-2: A1C ≥6.5% Threshold for Retinopathy Colagiuri S et al. Diabetes Care 2011; 34:145-150. Any retinopathy ≥ moderate NPDR 4.0 4.5 5.0 5.5 6.0 6.5 7.0 7.5 8.0 8.5 9.0 9.5 15.0+ 10.0 10.5 11.0 11.5 12.0 12.5 13.0 13.5 14.0 14.5 45 40 35 30 25 20 15 Prevalence (%) FPG by 0.5 mmol/L intervals 4.0 5.0 6.0 7.0 8.0 9.0 18.0+ 12.0 11.0 13.0 10.0 14.0 15.0 16.0 17.0 Prevalence (%) 2hPG by 0.5 mmol/L intervals 45 40 35 30 25 20 15 10 4.0 5.5 6.0 6.5 7.0 7.5 12.0+ 9.0 8.5 9.5 8.0 10.0 10.5 11.0 11.5 Prevalence (%) HbA1c by 0.5% intervals 5.0 4.5 5 0 45 40 35 30 25 20 15 10 5 0 5 0 10 A1C, glycated hemoglobin; FPG, fasting plasma glucose; PG, plasma glucose
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Confirmatory test required In the absence of symptomatic hyperglycemia, if a single lab test result is in the diabetes range, a repeat confirmatory lab test (FPG, A1C, 2hPG in a 75 g OGTT) must be done on another day Repeat the same test (in a timely fashion) to confirm But a random PG in the diabetes range in an asymptomatic individual should be confirmed with an alternate test If results of two different tests are available and both are above the diagnostic thresholds, the diagnosis of diabetes is confirmed 2hPG, 2-hour plasma glucose; AlC, glycated hemoglobin; FPG, fasting plasma glucose; OGTT, oral glucose tolerance test; PG, plasma glucose. 2018 Diabetes Canada CPG – Chapter 3. Definition, Diagnosis & Classification of Diabetes, Prediabetes, Metabolic Syndrome
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Confirmatory test NOT required In the case of symptomatic hyperglycemia, the diagnosis has been made and a confirmatory test is not required before treatment is initiated. To avoid rapid metabolic deterioration in individuals in whom type 1 diabetes is likely (younger or lean or symptomatic hyperglycemia, especially with ketonuria or ketonemia), the initiation of treatment should not be delayed in order to complete confirmatory testing 2018 Diabetes Canada CPG – Chapter 3. Definition, Diagnosis & Classification of Diabetes, Prediabetes, Metabolic Syndrome 2hPG, 2-hour plasma glucose; AlC, glycated hemoglobin; FPG, fasting plasma glucose; OGTT, oral glucose tolerance test; PG, plasma glucose.
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Considerations when using A1C for Diagnosis Need validated standardized assay Repeat confirmatory test on another day Recognize conditions leading to misleading A1C A1C is not used for diagnosis in children, adolescents (as the sole diagnostic test), pregnant women as part of routine screening for gestational diabetes, those with cystic fibrosis or those with suspected type 1 diabetes Ethnicity and age can affect A1C results 2018 Diabetes Canada CPG – Chapter 3. Definition, Diagnosis & Classification of Diabetes, Prediabetes, Metabolic Syndrome
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Recognize pitfalls of A1C: conditions that can affect value 2018 Diabetes Canada CPG – Chapter 3. Definition, Diagnosis & Classification of Diabetes, Prediabetes, Metabolic Syndrome
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Pros and Cons of Diagnostic Tests 2018 Diabetes Canada CPG – Chapter 3. Definition, Diagnosis & Classification of Diabetes, Prediabetes, Metabolic Syndrome A1C, glycated hemoglobin; FPG, fasting plasma glucose; PG, plasma glucose
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Dealing with discordance in results Many people identified as having diabetes using A1C will not be identified as having diabetes by traditional glucose criteria, and vice versa. When results of more than one test are available (FPG, A1C, 2hPG in a 75-g OGTT) and the results are discordant, the test whose result is above diagnostic cut-point should be repeated, and the diagnosis made on basis of the repeat test. 2018 Diabetes Canada CPG – Chapter 3. Definition, Diagnosis & Classification of Diabetes, Prediabetes, Metabolic Syndrome A1C, glycated hemoglobin; FPG, fasting plasma glucose; OGTT, oral glucose tolerance test; PG, plasma glucose
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Diagnosis of prediabetes 2hPG, 2-hour plasma glucose; AlC, glycated hemoglobin; FPG, fasting plasma glucose; IFG, impaired fasting glucose; IGT, impaired glucose tolerance; OGTT, oral glucose tolerance test. 2018 Diabetes Canada CPG – Chapter 3. Definition, Diagnosis & Classification of Diabetes, Prediabetes, Metabolic Syndrome
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A1C Level and Future Risk of Diabetes: Systematic Review Zhang X et al. Diabetes Care. 2010;33:1665-1673. A1C, glycated hemoglobin 2018 Diabetes Canada CPG – Chapter 3. Definition, Diagnosis & Classification of Diabetes, Prediabetes, Metabolic Syndrome
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Definition of Metabolic Syndrome Adapted from: Alberti KG, et al. Circulation 2009;120:1640 † Commonly used drugs for elevated TG and reduced HDL-C are fibrates and nicotinic acid. A person taking one of these drugs can be presumed to have high TG and reduced HDL-C. High-dose omega-3 fatty acids presumes high TG
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Recommendation 1 Diabetes should be diagnosed by any of the following criteria: FPG ≥7.0 mmol/L [Grade B, Level 2] A1C ≥6.5% (for use in adults in the absence of factors that affect the accuracy of A1C and not for use in those with suspected type 1 diabetes) [Grade B, Level 2] 2hPG in a 75 g OGTT ≥11.1 mmol/L [Grade B, Level 2] Random PG ≥11.1 mmol/L [Grade D, Consensus] 2018 Diabetes Canada CPG – Chapter 3. Definition, Diagnosis & Classification of Diabetes, Prediabetes, Metabolic Syndrome
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Recommendation 1 cont’d In the presence of symptoms of hyperglycemia, a single test result in the diabetes range is sufficient to make the diagnosis of diabetes. In the absence of symptoms of hyperglycemia, if a single laboratory test result is in the diabetes range, a repeat confirmatory laboratory test (FPG, A1C, 2hPG in a 75 g OGTT) must be done on another day 2018 Diabetes Canada CPG – Chapter 3. Definition, Diagnosis & Classification of Diabetes, Prediabetes, Metabolic Syndrome
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Recommendation 1 cont’d It is preferable that the same test be repeated (in a timely fashion) for confirmation, but a random PG in the diabetes range in an asymptomatic individual should be confirmed with an alternate test. If results of two different tests are available and both are above the diagnostic cut-points, the diagnosis of diabetes is confirmed [Grade D, Consensus] 2018 Diabetes Canada CPG – Chapter 3. Definition, Diagnosis & Classification of Diabetes, Prediabetes, Metabolic Syndrome
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To avoid rapid metabolic deterioration in individuals in whom type 1 diabetes is likely (younger or lean or symptomatic hyperglycemia, especially with ketonuria or ketonemia), the initiation of treatment should not be delayed in order to complete confirmatory testing [Grade D, Consensus] Recommendation 1 cont’d 2018 Diabetes Canada CPG – Chapter 3. Definition, Diagnosis & Classification of Diabetes, Prediabetes, Metabolic Syndrome
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Recommendation 2 2. Prediabetes (defined as a state which places individuals at high risk of developing diabetes and its complications) is diagnosed by any of the following criteria: IFG (FPG 6.1-6.9 mmol/L) [Grade A, Level 1] IGT (2hPG in a 75 g OGTT 7.8-11.0 mmol/L) [Grade A, Level 1] A1C 6.0%-6.4% (for use in adults in the absence of factors that affect the accuracy of A1C and not for use in suspected type 1 diabetes) [Grade B, Level 2] 2018 Diabetes Canada CPG – Chapter 3. Definition, Diagnosis & Classification of Diabetes, Prediabetes, Metabolic Syndrome
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Key Messages The chronic hyperglycemia of diabetes is associated with significant long-term microvascular and CV complications A FPG of ≥7.0 mmol/L, a 2hPG value in a 75 g OGTT of ≥11.1 mmol/L or an A1C of ≥6.5% can predict the development of retinopathy. This permits the diagnosis of diabetes to be made on the basis of each of these parameters 2018 Diabetes Canada CPG – Chapter 3. Definition, Diagnosis & Classification of Diabetes, Prediabetes, Metabolic Syndrome
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Key Messages The term "prediabetes" refers to impaired fasting glucose, impaired glucose tolerance or an A1C of 6.0% to 6.4%, each of which places individuals at increased risk of developing diabetes and its complications 2018 Diabetes Canada CPG – Chapter 3. Definition, Diagnosis & Classification of Diabetes, Prediabetes, Metabolic Syndrome
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Key Messages for People with Diabetes There are two main types of diabetes. Type 1 diabetes occurs when the pancreas is unable to produce insulin. Type 2 diabetes occurs when the pancreas does not produce enough insulin or when the body does not effectively use the insulin that is produced Gestational diabetes is a type of diabetes that is first recognized or begins during pregnancy Monogenic diabetes is a rare disorder caused by genetic defects of beta cell function 2018 Diabetes Canada CPG – Chapter 3. Definition, Diagnosis & Classification of Diabetes, Prediabetes, Metabolic Syndrome
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Key Messages for People with Diabetes Prediabetes refers to blood glucose levels that are higher than normal, but not yet high enough to be diagnosed as type 2 diabetes. Although not everyone with prediabetes will develop type 2 diabetes, many people will You should discuss the type of diabetes you have with your diabetes health-care team There are several types of blood tests that can be done to determine if a person has diabetes and, in most cases, a confirmatory blood test is required to be sure 2018 Diabetes Canada CPG – Chapter 3. Definition, Diagnosis & Classification of Diabetes, Prediabetes, Metabolic Syndrome
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Visit guidelines.diabetes.ca
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Or download the App
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Diabetes Canada Clinical Practice Guidelines http://guidelines.diabetes.ca – for health-care providers 1-800-BANTING (226-8464) http://diabetes.ca – for people with diabetes