Role of the Laboratory in Screening and Diagnosis of Diabetes Mellitus
المؤلف:
Marcello Ciaccio
المصدر:
Clinical and Laboratory Medicine Textbook 2021
الجزء والصفحة:
p399-400
2025-10-29
55
Concerning preclinical diagnosis (screening), it is useful to treat type 1 diabetes separately from type 2 and gestational diabetes.
For type 1 diabetes, various evidence from studies on ani mal models suggests that an immune therapeutic intervention before the onset of symptoms can delay or prevent their onset. However, the numerous clinical trials conducted on humans have produced disappointing results. Nevertheless, the ADA recommends that first-degree relatives of patients with type 1 diabetes be screened for autoantibodies, specific markers of immune aggression to β-cells, with the recommendation that those who screen positive should then be referred to specialist centers.
Human leukocyte antigen genotype research, perhaps interesting from a research point of view, is not currently recommended for diabetes screening. Similarly, measurement of insulin secretion, the first functional abnormality found at the onset of both type 1 and type 2 diabetes, is not currently recommended in routine laboratory testing.
Screening for type 2 diabetes in asymptomatic subjects has been a matter of much controversy. However, the rationale is that since it is estimated that, on average, about 30% of individuals with type 2 diabetes have the disease without having yet received a diagnosis, to prevent com plications, the diagnosis should be made as early as possible. Currently, the ADA recommends screening for all asymptomatic individuals over 45 years of age. Screening can be done on younger subjects in the presence of risk factors (e.g., in the case of familial or ethnic group membership). In particular, based on the increasing prevalence of type 2 diabetes among adolescents, screening is recommended if there are conditions associated with increased insulin resistance or if there is a history of diabetes in the mother before pregnancy or gestational diabetes. Screening should be repeated every 3 years, starting at age 10.
In some countries, there may be significant differences. For example, in Israel, the prevalence of undiagnosed diabetes is negligible; the entire population is subjected continuously throughout their lives (at school age, during and after military service, etc.) to rigorous medical testing.
Finally, as regards the diagnosis, in the absence of symptoms, the measurement of fasting blood glucose, glycated hemoglobin (HbA1c), or the oral glucose tolerance test (OGTT) can be performed and should be repeated on a second occasion. See below for threshold values and interpretation.
الاكثر قراءة في التحليلات المرضية
اخر الاخبار
اخبار العتبة العباسية المقدسة
