Diabetes Mellitus: Screening Guidelines with Case

by Charles Vega, MD

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    00:01 Diabetes mellitus is the most common diagnosis in my practice.

    00:05 So, I feel like I know it really well and I think I’ve got some good information to give you, particularly regarding diagnosis and management.

    00:13 So, let’s get underway.

    00:15 So, I've got a patient who is six years old.

    00:19 He's got hyperlipidemia and obesity.

    00:21 A recent routine lab analysis found that his serum glucose level was 146 mg/dL.

    00:29 He’s asymptomatic at this time.

    00:32 What’s the next best step in his care? Should we talk about lifestyle changes and recheck his glucose, along with a hemoglobin A1c level in the next several weeks? Should we start metformin now or sulfonylurea or dipeptidyl peptidase-4 inhibitor? What do you think? Given his lack of symptoms and that glucose level, we are mandated to recheck his glucose level.

    00:57 And I would check an A1c too because, with his risk factors, sounds like he probably has diabetes.

    01:02 Of course, you’re going to advise him on lifestyle changes now, and so that makes sense.

    01:06 He does not have -- meet the formal criteria for diabetes as of yet, but many people do.

    01:14 Overall, there are now more than 20 million Americans with Type II diabetes and this number is expected to more than double within the next 20 years or so.

    01:26 So, should we be screening for diabetes? Well, this is what the United States Preventive Services Task Force, or USPSTF, says.

    01:34 Among adults aged 40 to 70 years, which is kind of the sweet spot for identifying diabetes, check for either glucose or A1c, either one is a valid measure, among patients who are obese and among those with a family history of diabetes, high risk racial or ethnic groups, which include Latinos and African-Americans.

    01:55 And if the patient has a history of gestational diabetes or polycystic ovary syndrome, those patients get screened too.

    02:01 Lots of people meet the screening criteria.

    02:04 You can apply that fairly broadly across a population.

    About the Lecture

    The lecture Diabetes Mellitus: Screening Guidelines with Case by Charles Vega, MD is from the course Chronic Care.

    Included Quiz Questions

    1. Fasting plasma glucose, glycated hemoglobin
    2. Glycated hemoglobin, 50 gram 1-hour glucose screen
    3. Fasting plasma glucose, 100 gram three-hour oral glucose tolerance test
    4. 50 gram 1-hour glucose screen, fasting plasma glucose
    5. 100 gram three-hour oral glucose tolerance test, glycated hemoglobin
    1. A healthy 72-year-old woman with a normal weight
    2. A 56-year-old obese man
    3. A hypertensive 56-year-old woman
    4. A 42-year-old man with a BMI of 25 kg/m2
    5. A healthy 62-year-old woman with hyperlipidemia

    Author of lecture Diabetes Mellitus: Screening Guidelines with Case

     Charles Vega, MD

    Charles Vega, MD

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