UpToDate 2025
🔹 معیارهای تشخیص دیابت
1️⃣ FPG (fasting plasma glucose) ≥126 mg/dL; Fasting is defined as no caloric intake for at least eight hours.
OR
2️⃣ Two-hour plasma glucose values of ≥200 mg/dL during a 75 g OGTT;
❗️OGTT is not commonly used (except during pregnancy) owing to its inconvenience.
OR
3️⃣ A1C values ≥6.5 percent.
OR
4️⃣ Classic symptoms of hyperglycemia (increased thirst, polyuria, weight loss, blurry vision) AND has a random plasma
glucose value of 200 mg/dL
⚠️ برای سه معیار اول: یا باید دو تست متفاوت همزمان درخواست شود و هر دو مختل باشند یا اگر فقط یکی از تست‌ها مختل بود، باید همان تست مختل در روز دیگری تکرار شود و اگر باز هم بالا بود، تشخیص دیابت گذاشته می‌شود.
⚠️ اگر بیمار HHS/DKA باشد تشخیص دیابت را بدون توجه به معیارهای بالا میگذاریم.
🔸 A1c is preferred test; alternatively we can use FPS with without A1c.
🔹 معیارهای تشخیص پره دیابت
1️⃣ Impaired fasting glucose (IFG) – FPG between 100 and 125 mg/dL
OR
2️⃣ Impaired glucose tolerance (IGT) – Two-hour plasma glucose value during a 75 g OGTT between 140 and 199 mg/dL.
OR
3️⃣ A1C – A1C 5.7 to <6.5 percent
⚠️ If the diagnostic test is consistent with prediabetes, it should be repeated annually.
⚠️ Individuals with prediabetes should be evaluated and treated for other cardiovascular risk factors.
▫️We should consider Transient "stress" hyperglycemia as DDxs that may occur during severe illness in adults without known diabetes mellitus.
▪️آزمایشات اولیه در بیمار با دیابت تایپ ۲ تازه تشخیص داده‌شده:
▫️If not measured in the past two to three months, we measure A1C.
▫️If not measured in the past one year, we measure:
➖ Fasting lipid profile
➖ Liver function tests
➖ Urine albumin-to-creatinine ratio (spot urine)
➖ Serum creatinine (with eGFR)
🔹غربالگری قند خون در چه افرادی نیاز است؟
For adults ages 35 to 70 years who are at increased risk for diabetes and/or have cardiovascular risk factors. This includes individuals with:
• overweight and obesity (BMI ≥25),
• prior gestational diabetes,
• polycystic ovary syndrome,
• HIV disease,
• first-degree relative with type 2 diabetes,
• hypertension,
• dyslipidemia (HDL <35 and/or TG >250)
• physical inactivity
• established cardiovascular disease
• History of pancreatitis,
• Exposure to high-risk medications (eg, glucocorticoids, second-generation antipsychotics, HIV antiretrovirals, immune checkpoint inhibitors, thiazide diuretics, high-potency statins)
☝🏻 Frequency of rescreening – We rescreen individuals with normal test results at three-year intervals and those with prediabetes at one year.
▫️We typically stop screening in individuals over age 70 years.
⚠️ این بخش غربالگری کمی با ADA متفاوت است.
🔹پیشگیری از دیابت تایپ ۲
All individuals with prediabetes are candidates for preventive measures:
1️⃣ Lifestyle modification:
• Modest weight loss (≥7 percent of body weight)
• Moderate-intensity exercise (≥150 minutes per week)
• Smoking cessation
2️⃣ Pharmacologic therapy (esp for)
• age <60 years
• BMI ≥35
• women with a history of gestational diabetes.
💊 Metformin; 850 mg once daily for one month; if tolerating, increase to 850 mg twice daily
💊 Semaglutide or Tirzepatide; in overweight or obesity
💊 Empiric vitamin D supplementation in people with prediabetes is reasonable.
⚠️ Drugs not recommended for prevention of T2DM:
• Insulin
• Pioglitazone
• Rosiglitazone
• Orlistat
• Alpha-glucosidase inhibitors (eg, acarbose, voglibose)
• SGLT2 inhibitors
• Nateglinide
• Liraglutide
• Estrogen
• Anti-hypertension medications
▫️ There are few data evaluating the ability of bariatric surgery to prevent diabetes in individuals with obesity