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Classification and Laboratory Diagnosis of Diabetes Mellitus

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Endocrinology and Diabetes

Abstract

Diabetes mellitus is a metabolic disorder of various etiologies, characterized by impairment of insulin secretion and action. This results in hyperglycemia and a number of clinical manifestations and serious complications. Identification and understanding of the specific etiology of an individual’s diabetes is important as it guides treatment decisions. Diabetes is often diagnosed in the absence of classic symptoms, and thus the diagnosis is heavily reliant on biochemical measures. Over the years, there have been numerous changes in the classification of diabetes as well as the criteria and methods for diagnosis. As new data have become available and assay methodologies have been updated, diagnostic thresholds have been altered. In recent years, hemoglobin A1c has also been adopted as an alternate diagnostic measure to plasma glucose levels for type 2 diabetes. There have also been advances in gene and autoantibody testing for the determination of diabetes type. This chapter reviews the different types of diabetes and the laboratory measures and associated criteria used for diagnosis.

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Abbreviations

2hPG:

2-hour plasma glucose

ADA:

American Diabetes Association

BMI:

Body mass index

DKA:

Diabetic ketoacidosis

DM:

Diabetes mellitus

FPG:

Fasting plasma glucose

GAD :

Glutamic acid decarboxylase

GDM:

Gestational diabetes mellitus

HbA1c:

Hemoglobin A1c

IADPSG:

International Association of Diabetes and Pregnancy Study Groups

ICA:

Islet cell antibody

IFG:

Impaired fasting glycemia

IGT:

Impaired glucose tolerance

LADA:

Latent autoimmune diabetes of adulthood

MODY:

Maturity-onset diabetes of the young

OGTT:

Oral glucose tolerance test

WHO:

World Health Organization

References

  1. World Health Organization. Definition and diagnosis of diabetes mellitus and intermediate hyperglycemia. Report of a WHO/IDF consultation. Geneva; 2006.

    Google Scholar 

  2. American Diabetes Association. 2. Classification and diagnosis of diabetes: standards of medical care in diabetes-2018. Diabetes Care. 2018;41(supp 1):S13–27.

    Article  Google Scholar 

  3. Himsworth HP. Diabetes mellitus: its differentiation into insulin-sensitive and insulin-insensitive types. Lancet. 1936;1:117.

    Google Scholar 

  4. Bornstein J, Lawrence RD. Plasma insulin in human diabetes mellitus. Br Med J. 1951;2:1541–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Berson SA, Yalow RS. Immunoassay of endogenous plasma insulin in man. J Clin Invest. 1960;39:1157–75.

    Article  PubMed  PubMed Central  Google Scholar 

  6. World Health Organization. Second report of the WHO expert committee on diabetes mellitus. Technical report series no. 646. Geneva; 1980.

    Google Scholar 

  7. World Health Organization. Definition, diagnosis and classification of diabetes mellitus and its complications—report of a WHO consultation 1999 (WHO/NCD/NCS 99.2). Geneva; 1999.

    Google Scholar 

  8. American Diabetes Association Expert Committee. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care. 1997;20:1183–97.

    Article  Google Scholar 

  9. Miller HC. The effect of diabetic and prediabetic pregnancies on the fetus and newborn infant. J Pediatr. 1946;26:455–61.

    Article  Google Scholar 

  10. O’Sullivan JB, Mahan CM. Criteria for the oral glucose tolerance test in pregnancy. Diabetes. 1964;13:278–85.

    PubMed  Google Scholar 

  11. World Health Organization. Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy. Geneva; 2013.

    Google Scholar 

  12. IADPS. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010;33(3):676–82.

    Article  Google Scholar 

  13. UKPDS. Overview of six years’ therapy of type 2 diabetes—a progressive disease. Diabetes. 1995;44:1248–58.

    Google Scholar 

  14. Leslie RD, Williams R, Pozzilli P. Clinical review: type 1 diabetes and latent autoimmune diabetes in adults: one end of the rainbow. J Clin Endocrinol Metab. 2006;91:1654–9.

    Article  PubMed  Google Scholar 

  15. Stenstrom G, Gottsater A, Bakhtadz E, Berger B, Sundkvist G. Latent autoimmune diabetes in adults. Diabetes. 2005;54:S68–72.

    Article  PubMed  Google Scholar 

  16. Pozzilli P, Di Mario U. Autoimmune diabetes not requiring insulin at diagnosis (latent autoimmune diabetes of the adult): definition, characterization, and potential prevention. Diabetes Care. 2001;24:1460–7.

    Article  CAS  PubMed  Google Scholar 

  17. Umpierrez GE, Smiley D, Kitabchi AE. Narrative review: ketosis-prone type 2 diabetes mellitus. Ann Intern Med. 2006;144:350–7.

    Article  PubMed  Google Scholar 

  18. Mauvais-Jarvis F, Sobngwi E, Porcher R, Riveline J-P, Kevorkian J-P, Vaisse C, et al. Ketosis-prone type 2 diabetes in patients of sub-Saharan African origin: clinical pathophysiology and natural history of β-cell dysfunction and insulin resistance. Diabetes. 2004;53:645–53.

    Article  CAS  PubMed  Google Scholar 

  19. Umpierrez GE, Casals MM, Gebhart SP, Mixon PS, Clark WS, Phillips LS. Diabetes ketoacidosis in obese African-Americans. Diabetes. 1995;44:790–5.

    Article  CAS  PubMed  Google Scholar 

  20. Banerji MA, Chaiken RL, Lebovitz HE. Long-term normoglycemic remission in black newly diagnosed NIDDM subjects. Diabetes. 1996;45:337–41.

    Article  CAS  PubMed  Google Scholar 

  21. Umpierrez GE, Clark WS, Steen MT. Sulphonylurea treatment prevents recurrence of hyperglycemia in obese African-American patients with a history of hyperglycemic crises. Diabetes Care. 1997;20:479–83.

    Article  CAS  PubMed  Google Scholar 

  22. Hattersley AT, Patel KA. Precision diabetes: learning from monogenic diabetes. Diabetologia. 2017;60(5):769–77.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Misra S, Hattersley AT. Chapter 18: monogenic causes of diabetes. In: Textbook of diabetes. 5th ed. UK: Wiley-Blackwell; 2016.

    Google Scholar 

  24. Chakera AJ, Steele AM, Gloyn AL, Shepherd MH, Shields B, Ellard S, Hattersley AT. Recognition and management of individuals with hyperglycemia because of a heterozygous glucokinase mutation. Diabetes Care. 2015;38(7):1383–92.

    Article  CAS  PubMed  Google Scholar 

  25. DiabetesGenes.org, MODY Probability Calculator, Accessed via: www.diabetesgenes.org/content/mody-probability-calculator/. Accessed on: 28th December 2017.

  26. Aroda VR, Ratner R. Approach to the patient with prediabetes. J Clin Endocrinol Metab. 2008;93:3259–65.

    Article  CAS  PubMed  Google Scholar 

  27. Insel RA, Dunne JL, Atkinson MA, Chiang JL, Dabelea D, Gottlieb PA, et al. Staging presymptomatic type 1 diabetes: a scientific statement of JDRF, the Endocrine Society, and the American Diabetes Association. Diabetes Care. 2015;38(10):1964–74.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Hare MJL, Shaw JE, Zimmet PZ. Diagnosing diabetes mellitus in the twenty-first century – what is the role of haemoglobin A1c? Hamdan Med J. 2012;5:123–30.

    Article  Google Scholar 

  29. Colagiuri S, Lee CM, Wong TY, Balkau B, Shaw JE, Borch-Johnsen K, et al. Glycemic thresholds for diabetes-specific retinopathy: implications for diagnostic criteria for diabetes. Diabetes Care. 2011;34(10):145–50.

    Article  PubMed  Google Scholar 

  30. The HAPO Study Cooperative Research Group. Hyperglycemia and adverse pregnancy outcomes. N Eng J Med. 2008;358(18):1991–2002.

    Google Scholar 

  31. International Expert Committee. International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care. 2009;32:1327–34.

    Article  Google Scholar 

  32. Mikesh LM, Bruns DE. Stabilization of glucose in blood specimens: mechanism of delay in fluoride inhibition of glycolysis. Clin Chem. 2008;54:930–2.

    Article  CAS  PubMed  Google Scholar 

  33. Bruns DE, Knowler WC. Stabilization of glucose in blood samples: why it matters. Clin Chem. 2009;55:850–2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Sicree RA, Zimmet PZ, Dunstan DW, Cameron AJ, Welborn TA, Shaw JE. Differences in height explain gender differences in the response to the oral glucose tolerance test – the AusDiab study. Diabet Med. 2008;25:296–302.

    Article  CAS  PubMed  Google Scholar 

  35. Hare MJL, Shaw JE, Zimmet PZ. Current controversies in the use of haemoglobin A1c. J Intern Med. 2012;271(3):227–36.

    Article  CAS  PubMed  Google Scholar 

  36. Tahara Y, Shima K. The response of glycated hemoglobin to stepwise plasma glucose change over time in diabetic patients. Diabetes Care. 1993;16:1313–4.

    Article  CAS  PubMed  Google Scholar 

  37. Little RR, Rohlfing CL, Wiedmeyer HM, Myers GL, Sacks DB, Goldstein DE. The national glycohemoglobin standardization program: a five-year progress report. Clin Chem. 2001;47:1985–92.

    CAS  PubMed  Google Scholar 

  38. Hoelzel W, Weykamp C, Jeppsson JO, Miedema K, Barr JR, Goodall I, et al. IFCC reference system for measurement of hemoglobin A1c in human blood and the national standardization schemes in the United States, Japan, and Sweden: a method-comparison study. Clin Chem. 2004;50:166–74.

    Article  CAS  PubMed  Google Scholar 

  39. Nathan DM, Kuenen J, Borg R, Zheng H, Schoenfeld D, Heine RJ. Translating the AIC assay into estimated average glucose values. Diabetes Care. 2008;31(8):1473–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. World Health Organization. Use of glycated hemoglobin (HbA1c) in the diagnosis of diabetes mellitus—abbreviated report of a WHO consultation. Geneva; 2011.

    Google Scholar 

  41. Bonora E, Tuomilehto J. The pros and cons of diagnosing diabetes with A1c. Diabetes Care. 2011;34 Suppl 2:S184–90.

    Article  PubMed  Google Scholar 

  42. Centers for Disease Control and Prevention: national diabetes fact sheet: general information and national estimates on diabetes in the United States, 2011. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2011.

    Google Scholar 

  43. Casparie AF, Miedema K. Glycosylated hemoglobin in diabetes and renal failure. Lancet. 1977;2(8041):758–9.

    Article  CAS  PubMed  Google Scholar 

  44. De Boer MJ, Miedema K, Casparie AF. Glycosylated hemoglobin in renal failure. Diabetologia. 1980;18(6):437–40.

    Article  PubMed  Google Scholar 

  45. Eschbach JW Jr, Funk D, Adamson J, Kuhn I, Scribner BH, Finch CA. Erythropoiesis in patients with renal failure undergoing chronic dialysis. N Engl J Med. 1967;276:653–8.

    Article  PubMed  Google Scholar 

  46. Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329:977–86.

    Article  Google Scholar 

  47. Desimone ME, Weinstock RS. Endotext, diabetes and carbohydrate metabolism chapter 11: pancreatic islet function tests. Updated 29 October 2015. Accessed 27 Dec 2017.

    Google Scholar 

  48. Delli AJ, Larsson HE, Ivarsson SA, Lernmark AK, Kong APS, Chan JCN. Type 1 diabetes. In: Textbook of diabetes. 4th ed. UK: Wiley-Blackwell. p. 141–52.

    Google Scholar 

  49. Lee YS, Ng WY, Thai AC, Lui KF, Loke KY. Prevalence of ICA and GAD antibodies at initial presentation of type 1 diabetes mellitus in Singapore children. J Pediatr Endocrinol Metab. 2001;14:767–72.

    Article  CAS  PubMed  Google Scholar 

  50. Sanjeev CB, Hagopian WA, Landin-Olsson M, Kockum I, Woo W, Palmer JP, et al. Association between autoantibody markers and subtypes of DR4 and DR4-DQ in Swedish children with insulin-dependent diabetes reveals closer association of tyrosine pyrophosphatase autoimmunity with DR4 than DQ8. Tissue Antigens. 1998;51:281–6.

    Article  Google Scholar 

  51. Vardi P, Ziegler AG, Mathews JH, Dib S, Keller RJ, Ricker AT, et al. Concentration of insulin autoantibodies at onset of type 1 diabetes: inverse log-linear correlation with age. Diabetes Care. 1988;11:736–9.

    Article  CAS  PubMed  Google Scholar 

  52. Graham J, Hagopian WA, Kockum I, Li LS, Sanjeevi CB, Lowe RM, et al. Genetic effects on age-dependent onset and islet cell autoantibody markers in type 1 diabetes. Diabetes. 2002;51:1346–55.

    Article  CAS  PubMed  Google Scholar 

  53. Barker JM, Barriga KJ, Yu LP, Miao DM, Erlich HA, Norris JM, et al. Prediction of autoantibody positivity and progression to type 1 diabetes: diabetes autoimmunity study in the young (DAISY). J Clin Endocrinol Metab. 2004;89:3896–902.

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Endocrinology and Diabetes, The Alfred, Melbourne, VIC, Australia

    Matthew J. L. Hare & Duncan J. Topliss

  2. Department of Medicine, Monash University, Clayton, VIC, Australia

    Duncan J. Topliss

Authors
  1. Matthew J. L. Hare
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  2. Duncan J. Topliss
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Corresponding author

Correspondence to Matthew J. L. Hare .

Editor information

Editors and Affiliations

  1. Division of Endocrinology, Agamenon Magalhães Hospital, University of Pernambuco Medical School, Recife, Pernambuco, Brazil

    Francisco Bandeira

  2. Division of Endocrinology, Mayo Clinic College of Medicine, Rochester, MN, USA

    Hossein Gharib

  3. School of Medicine, University of Pernambuco, Recife, Brazil

    Luiz Griz

  4. School of Medicine, University of Maranhao, Sao Luis, Brazil

    Manuel Faria

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Hare, M.J.L., Topliss, D.J. (2022). Classification and Laboratory Diagnosis of Diabetes Mellitus. In: Bandeira, F., Gharib, H., Griz, L., Faria, M. (eds) Endocrinology and Diabetes. Springer, Cham. https://doi.org/10.1007/978-3-030-90684-9_28

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  • DOI: https://doi.org/10.1007/978-3-030-90684-9_28

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  • Publisher Name: Springer, Cham

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  • Online ISBN: 978-3-030-90684-9

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