Glucose Tolerance Test

Diabetes Mellitus
Dr. David Gee
FCSN 442 - Nutrition Assessment Laboratory

Prevalence
2006

20.8 million Americans

7% population
9.6% adults over 20 years
21% adults over 60 years
30% undiagnosed
6.2 million undiagnosed
41 million with pre-diabetes

Implications of the Diabetes

Control and Complications Trial
Diabetes Care 25:S25-S27, 2002

Conventional Treatment vs Intensive Treatment

IT had lower HA1C and FBG

Average 7 year follow up

Measured outcomes:
Retinopathy, nephropathy, neuropathy

Results:
60% reduction in risk in intensive treatment group

Report of the Expert

Committee on the Diagnosis
and Classification of
Diabetes Mellitus
Diabetes Care 28:S4-S36, 2005
See at
Diabetes.org
For health professionals
2005 clinical practice recommendations

Criteria for testing for DM in

assymptomatic, undiagnosed patients
>

45 yrs, every 3 yrs (if normal)

< 45 yrs, every 3 yrs if:
BMI > 25 and any of the following
1st degree relative with DM
Blacks, Hispanic, Native American, Asian American
Habitually inactive
Hx Gestational Diabetes or baby > 9 lbs
History of vascular disease

Criteria for testing for DM in

assymptomatic, undiagnosed
patients
< 45 yrs, every 3 yrs if: (cont.)
Hypertension (>140/90)
HDL < 35 mg/dl
TG > 250 mg/dl
previous Dx of impaired glucose
tolerance or impaired fasting glucose

Testing of children for Type 2

Diabetes

Criteria
Overweight (BMI >85th percentile for age and sex, weight
for height >85th percentile, or weight >120% of ideal for
height)
Plus any two of the following risk factors

Family history of Type 2 DM, 1o or 2o

Native American, black, asian, latino
Signs of insulin resistance (acanthosis nigricans, hypertension,
dyslipidemia)

Age of initiation: 10 yrs or onset of puberty

Frequency every two years
Test: FBG test preferred

Acanthosis nigricans

Fasting Blood Glucose

>

8 hr fast
DM if FBG > 126 mg/dl (7.0mM)
on 2 occasions
Pre-Diabetes

Impaired fasting glucose (IFG)

if : 110 - 125 mg/dl

Casual Plasma Glucose

Casual is defined as any time of day without
regard to time since last meal
> 200 mg/dl (11.1mM) plus

Symptoms of diabetes

Polyuria, polydipsea, unexplained weight loss

Confirm on subsequent visit with fasting

blood glucose or oral glucose tolerance test

Glucose Tolerance Testing

for
adults with impaired FBG
during pregnancy if at risk

Procedure
Following 8 hour fast
Glucose dose = 1.75g/kg IBW
Maximum 75 g dose (BW<43kg, 94lbs)
25 g/dl glucose test solution
Test at 2 hours

Diagnostic Criteria
DM

if [glu] > 200 mg/dl at 2 hours

IGT if [glu] >140 - 199 at 2 hours
normal if [glu] < 140 mg/dl
IGT and IFT recently termed prediabetic

Hemoglobin A1c
glycated hemoglobin

Average lifespan of red blood cells

~ 120 days (4 months)

Glycosylation of blood proteins in

proportion to blood glucose concentration
Normal: 5%
Goal for diabetics: < 7%