-
Categories
-
Pharmaceutical Intermediates
-
Active Pharmaceutical Ingredients
-
Food Additives
- Industrial Coatings
- Agrochemicals
- Dyes and Pigments
- Surfactant
- Flavors and Fragrances
- Chemical Reagents
- Catalyst and Auxiliary
- Natural Products
- Inorganic Chemistry
-
Organic Chemistry
-
Biochemical Engineering
- Analytical Chemistry
-
Cosmetic Ingredient
- Water Treatment Chemical
-
Pharmaceutical Intermediates
Promotion
ECHEMI Mall
Wholesale
Weekly Price
Exhibition
News
-
Trade Service
*For medical professionals only, this
article is for reference
.
This article explains 7 major misunderstandings in the diagnosis and classification of diabetes:
Myth 1: Heavy fasting blood sugar and light postprandial blood sugar
In the diagnosis and treatment of type 2 diabetes mellitus (T2DM), attention should not only be paid to fasting blood glucose, but also to postprandial blood glucose
.
Studies have shown that postprandial blood glucose elevations occur earlier than fasting glucose increases after progression to diabetes and continue throughout the course of the disease [1].
A growing number of studies also confirm the importance of postprandial blood glucose: it contributes more to glycemic control than fasting blood glucose [2], and is closely related to the occurrence of multiple complications [3].
China's epidemiological data show that only fasting blood glucose is checked, the missed rate of diabetes is high, and the ideal investigation is to detect fasting blood glucose, OGTT-2h blood glucose and HbA1c for the diagnosis of diabetes [4].
Myth 2: A positive urine glucose is diagnosed as diabetes
Urine glucose levels can only simply reflect the approximate value of blood sugar levels, and do not accurately reflect the body's blood sugar levels
.
Some patients have a long course of diabetes and are accompanied by glomerular arteriosclerosis, which increases the renal glucose threshold, urine glucose test is negative, but there is an increase in blood glucose level; In addition, some people have abnormal kidney function, low renal glucose threshold, and may also test positive
for urine glucose when blood glucose levels are normal.
Therefore, suspected patients should be further tested for blood glucose and comprehensively judged [5].
The following conditions can lead to urine glucose positivity [6]:
★ the secretion of insulin antagonists during stress is significantly increased, which can make urine glucose positive in some patients, After stress, most patients return to normal blood sugar levels, and a small number develop diabetes
.
★ Glucose filtration in the glomerulus is increased during pregnancy, and the absorption of sugar by the renal tubules is reduced, resulting in a positive urine glucose, which usually occurs in the first 3 months of pregnancy, and urine glucose disappears
after delivery.
★ A large number of drugs such as vitamin C, salicylic acid, and penicillin can cause false-positive reactions
to urine glucose.
★ Decreased
renal glucose threshold due to various other causes.
Myth 3: Diagnosing diabetes with the typical symptoms of "three more and one less"
Some patients do not have the typical symptoms of "three more and one less" (polyuria, polydipsia, polyphagia, and weight loss) early in the disease but do not negate diabetes
.
Most patients with T2DM are asymptomatic at diagnosis, have occult hyperglycemia, and in the long term, diabetes can involve all organs of the body (complications), and the clinical manifestations are complex [7].
The first symptom in some patients is a clinical feature of complications [8]:
★ Patients with late-onset insulin-dependent diabetes mellitus are misdiagnosed as acute abdomen because they often have ketoacidosis as the first manifestation in young adults, and nausea, vomiting, and abdominal pain occur
.
★ Diabetes mellitus, such as lung infection, urinary infection, and skin infection, is often misdiagnosed
.
★16% of diabetic patients are first diagnosed in ophthalmology with ophthalmic complications such as cataracts and retinopathy, which are prone to misdiagnosis
.
★10%-16% of pediatric diabetes has an acute onset, polydipsis and polyuria symptoms are not easy to detect, and the onset
of ketoacidosis.
Some patients have a slow onset, manifested as weakness, weight loss, and decreased vision
.
Myth 4: Only do diagnosis and do not do typing
Diabetes is diagnosed without typing alone, but no etiology is classified
.
As a whole, diabetes is not a single cause of the disease, but a group of highly heterogeneous clinical syndromes caused by multiple factors such as genetics, environment, and behavior, including multiple etiologies and pathologies
.
The diagnosis and classification of diabetes is indispensable for the treatment of diabetes, and the etiological classification and diagnosis of diabetes is the premise of accurate treatment [9].
Myth 5: Childhood diabetes is type 1 diabetes mellitus (T1DM), and
elderly diabetes is T2DM
With the increasing age of obesity, the incidence of T2DM in adolescents increases [10].
Therefore, childhood diabetes is not necessarily T1DM, it may be T2DM.
Elderly diabetes is dominated by T2DM, but a few are T1DM.
Older patients with T1DM refer to those diagnosed before the age of 65 years ≥ and those diagnosed before the age of 65 years and later [11].
Studies in China have found that elderly adult occult autoimmune diabetes mellitus (LADA) is phenotypically and genetically different from young LADA, and the clinical and genetic characteristics of elderly LADA are more similar to elderly T2DM.
The clinical features of LADA in the elderly are atypical, so it is difficult to classify and diagnose, and it is easy to be misdiagnosed and missed [11].
Myth 6: A negative antibody test excludes
T1DM
Common islet autoantibodies include glutamate decarboxylase antibody (GADA), insulin autoantibody (IAA), islet cell antigen 2 antibody (IA-2A), and zinc transporter 8 antibody (ZnT8A).
It is mostly used to diagnose autoimmune T1DM.
If all three islet autoantibodies are negative and the clinical suspicion for T1DM is still high, the diagnosis
of idiopathic T1DM can be considered.
In addition, studies have shown that about 20% of patients with onset < 30 years and negative islet autoantibodies have monogenic diabetes
.
Therefore, genetic screening in patients with islet autoantibody-negative "idiopathic T1DM" should be emphasized to exclude monogenic diabetes [9].
Myth 7: Check only blood sugar and light other tests
A thorough assessment of the patient can also improve the patient's prognosis
by identifying diabetic complications and comorbidities in a timely manner and giving appropriate treatment.
Patients with diabetes should undergo a detailed evaluation at initial diagnosis [4]: fundus examination:
★ fundus photographs with a mydriatic fundus camera, If abnormal, referral to an ophthalmologist for further evaluation
.
★ Lesion examination: ankle reflex, needle prick pain, vibration sensation, pressure perception, temperature perception abnormal examination should be further electrophysiological examination (such as nerve conduction velocity measurement) and quantitative sensory measurement
.
★ Patients with hypertension or abnormal electrocardiogram or abnormal cardiac auscultation should have echocardiography; Patients with arrhythmias should have ambulatory electrocardiogram; Patients with hypertension should do ambulatory blood pressure monitoring to understand blood pressure fluctuations
throughout the day.
★ Patients with diabetes who are overweight or obese and those with diabetes with abnormal liver function should have abdominal ultrasonography and, if necessary, upper abdominal CT or magnetic resonance imaging
.
Monnier L,et al.
Diabetes Care.
2007 Feb; 30(2):263-9.
[2].
Wang JS, et al.
Diabetes Metab Res Rev.
2011 Jan; 27(1):79-84.
[3].
Lu J, et al.
Diabetes Care.
2019 Aug; 42(8):1539-1548.
[4].
Guidelines for the prevention and treatment of type 2 diabetes in China (2020 edition).
Chinese Journal of Endocrinology and Metabolism, 2021, 37(04): 311-398 HU Zhonghong, et al.
Clinical Medical Research and Practice,2016,1(19):39-40 TANG Haifeng, et al.
Rational use of diabetes treatment drugs[M].
People's Medical Publishing House, 2011.
P8-9 [7].
Imam K.
Adv Exp Med Biol.
2012; 771:340-55.
[8].
QIU Huizhi, et al.
Chinese Journal of Misdiagnosis,2001,1(6):942-943 Chinese expert consensus on diabetes typing and diagnosis[J].
Chinese Journal of Diabetes.
2022,14(2):120-139.
) [10].
TODAY Study Group,et al.
N Engl J Med.
2021 Jul 29; 385(5):416-426.
[11].
Interpretation of the Guidelines for the Diagnosis and Treatment of Diabetes in the Chinese Elderly (2021 Edition)——Focus on Type 1 diabetes in the elderly[J].
Journal of Clinical Internal Medicine,2022,39(5):289-292
, you can browse more endocrine frontier information without downloading
Call for Papers The Medical Endocrinology Channel welcomes your submissions! Click the link below or scan the QR code to submit: https://titan.
yishengzhan.
cn/#/public_contribution Please fill in the real information according to the call page*"The medical community" strives to publish the content professional and reliable, but does not promise the accuracy of the content; Relevant parties are requested to check
separately when adopting or using it as a basis for decision-making.
article is for reference
Guide
The diagnosis and classification of diabetes is well-founded and seemingly simple, but in actual clinical work, we often encounter some diagnostic difficulties, and it is difficult to make accurate and rapid judgments.
This article explains 7 major misunderstandings in the diagnosis and classification of diabetes:
- 4 major misunderstandings and detailed explanations of "blood sugar, urine sugar, symptoms, and physical examination" in diagnosis
- 3 major misunderstandings about typing and detailed explanation
Accurate diagnosis and classification of diabetes is the premise of precise treatment of diabetes, and diagnosis and classification are indispensable
.
However, there is no shortage of cases of misdiagnosis and missed diagnosis of diabetes in the clinic
.
This article summarizes 7 common diabetes diagnosis, classification, and symptom misunderstandings, and analyzes their causes and countermeasures.
Myth 1: Heavy fasting blood sugar and light postprandial blood sugar
Parse:
In the diagnosis and treatment of type 2 diabetes mellitus (T2DM), attention should not only be paid to fasting blood glucose, but also to postprandial blood glucose
.
Studies have shown that postprandial blood glucose elevations occur earlier than fasting glucose increases after progression to diabetes and continue throughout the course of the disease [1].
A growing number of studies also confirm the importance of postprandial blood glucose: it contributes more to glycemic control than fasting blood glucose [2], and is closely related to the occurrence of multiple complications [3].
China's epidemiological data show that only fasting blood glucose is checked, the missed rate of diabetes is high, and the ideal investigation is to detect fasting blood glucose, OGTT-2h blood glucose and HbA1c for the diagnosis of diabetes [4].
Myth 2: A positive urine glucose is diagnosed as diabetes
Parse:
Urine glucose levels can only simply reflect the approximate value of blood sugar levels, and do not accurately reflect the body's blood sugar levels
.
Some patients have a long course of diabetes and are accompanied by glomerular arteriosclerosis, which increases the renal glucose threshold, urine glucose test is negative, but there is an increase in blood glucose level; In addition, some people have abnormal kidney function, low renal glucose threshold, and may also test positive
for urine glucose when blood glucose levels are normal.
Therefore, suspected patients should be further tested for blood glucose and comprehensively judged [5].
The following conditions can lead to urine glucose positivity [6]:
★ the secretion of insulin antagonists during stress is significantly increased, which can make urine glucose positive in some patients, After stress, most patients return to normal blood sugar levels, and a small number develop diabetes
.
★ Glucose filtration in the glomerulus is increased during pregnancy, and the absorption of sugar by the renal tubules is reduced, resulting in a positive urine glucose, which usually occurs in the first 3 months of pregnancy, and urine glucose disappears
after delivery.
★ A large number of drugs such as vitamin C, salicylic acid, and penicillin can cause false-positive reactions
to urine glucose.
★ Decreased
renal glucose threshold due to various other causes.
Myth 3: Diagnosing diabetes with the typical symptoms of "three more and one less"
Parse:
Some patients do not have the typical symptoms of "three more and one less" (polyuria, polydipsia, polyphagia, and weight loss) early in the disease but do not negate diabetes
.
Most patients with T2DM are asymptomatic at diagnosis, have occult hyperglycemia, and in the long term, diabetes can involve all organs of the body (complications), and the clinical manifestations are complex [7].
The first symptom in some patients is a clinical feature of complications [8]:
★ Patients with late-onset insulin-dependent diabetes mellitus are misdiagnosed as acute abdomen because they often have ketoacidosis as the first manifestation in young adults, and nausea, vomiting, and abdominal pain occur
.
★ Diabetes mellitus, such as lung infection, urinary infection, and skin infection, is often misdiagnosed
.
★16% of diabetic patients are first diagnosed in ophthalmology with ophthalmic complications such as cataracts and retinopathy, which are prone to misdiagnosis
.
★10%-16% of pediatric diabetes has an acute onset, polydipsis and polyuria symptoms are not easy to detect, and the onset
of ketoacidosis.
Some patients have a slow onset, manifested as weakness, weight loss, and decreased vision
.
Myth 4: Only do diagnosis and do not do typing
Parse:
Diabetes is diagnosed without typing alone, but no etiology is classified
.
As a whole, diabetes is not a single cause of the disease, but a group of highly heterogeneous clinical syndromes caused by multiple factors such as genetics, environment, and behavior, including multiple etiologies and pathologies
.
The diagnosis and classification of diabetes is indispensable for the treatment of diabetes, and the etiological classification and diagnosis of diabetes is the premise of accurate treatment [9].
Myth 5: Childhood diabetes is type 1 diabetes mellitus (T1DM), and
elderly diabetes is T2DM
Parse:
With the increasing age of obesity, the incidence of T2DM in adolescents increases [10].
Therefore, childhood diabetes is not necessarily T1DM, it may be T2DM.
Elderly diabetes is dominated by T2DM, but a few are T1DM.
Older patients with T1DM refer to those diagnosed before the age of 65 years ≥ and those diagnosed before the age of 65 years and later [11].
Studies in China have found that elderly adult occult autoimmune diabetes mellitus (LADA) is phenotypically and genetically different from young LADA, and the clinical and genetic characteristics of elderly LADA are more similar to elderly T2DM.
The clinical features of LADA in the elderly are atypical, so it is difficult to classify and diagnose, and it is easy to be misdiagnosed and missed [11].
Myth 6: A negative antibody test excludes
T1DM
Parse:
Common islet autoantibodies include glutamate decarboxylase antibody (GADA), insulin autoantibody (IAA), islet cell antigen 2 antibody (IA-2A), and zinc transporter 8 antibody (ZnT8A).
It is mostly used to diagnose autoimmune T1DM.
If all three islet autoantibodies are negative and the clinical suspicion for T1DM is still high, the diagnosis
of idiopathic T1DM can be considered.
In addition, studies have shown that about 20% of patients with onset < 30 years and negative islet autoantibodies have monogenic diabetes
.
Therefore, genetic screening in patients with islet autoantibody-negative "idiopathic T1DM" should be emphasized to exclude monogenic diabetes [9].
Myth 7: Check only blood sugar and light other tests
Parse:
A thorough assessment of the patient can also improve the patient's prognosis
by identifying diabetic complications and comorbidities in a timely manner and giving appropriate treatment.
Patients with diabetes should undergo a detailed evaluation at initial diagnosis [4]: fundus examination:
★ fundus photographs with a mydriatic fundus camera, If abnormal, referral to an ophthalmologist for further evaluation
.
★ Lesion examination: ankle reflex, needle prick pain, vibration sensation, pressure perception, temperature perception abnormal examination should be further electrophysiological examination (such as nerve conduction velocity measurement) and quantitative sensory measurement
.
★ Patients with hypertension or abnormal electrocardiogram or abnormal cardiac auscultation should have echocardiography; Patients with arrhythmias should have ambulatory electrocardiogram; Patients with hypertension should do ambulatory blood pressure monitoring to understand blood pressure fluctuations
throughout the day.
★ Patients with diabetes who are overweight or obese and those with diabetes with abnormal liver function should have abdominal ultrasonography and, if necessary, upper abdominal CT or magnetic resonance imaging
.
References:
[1].Monnier L,et al.
Diabetes Care.
2007 Feb; 30(2):263-9.
[2].
Wang JS, et al.
Diabetes Metab Res Rev.
2011 Jan; 27(1):79-84.
[3].
Lu J, et al.
Diabetes Care.
2019 Aug; 42(8):1539-1548.
[4].
Guidelines for the prevention and treatment of type 2 diabetes in China (2020 edition).
Chinese Journal of Endocrinology and Metabolism, 2021, 37(04): 311-398 HU Zhonghong, et al.
Clinical Medical Research and Practice,2016,1(19):39-40 TANG Haifeng, et al.
Rational use of diabetes treatment drugs[M].
People's Medical Publishing House, 2011.
P8-9 [7].
Imam K.
Adv Exp Med Biol.
2012; 771:340-55.
[8].
QIU Huizhi, et al.
Chinese Journal of Misdiagnosis,2001,1(6):942-943 Chinese expert consensus on diabetes typing and diagnosis[J].
Chinese Journal of Diabetes.
2022,14(2):120-139.
) [10].
TODAY Study Group,et al.
N Engl J Med.
2021 Jul 29; 385(5):416-426.
[11].
Interpretation of the Guidelines for the Diagnosis and Treatment of Diabetes in the Chinese Elderly (2021 Edition)——Focus on Type 1 diabetes in the elderly[J].
Journal of Clinical Internal Medicine,2022,39(5):289-292
The web version of the doctor's station is online
Please scan the QR code below or click to read the original article, you can browse more endocrine frontier information without downloading
The source of this article Sugar Medical Network Responsible EditorOrange
Call for Papers The Medical Endocrinology Channel welcomes your submissions! Click the link below or scan the QR code to submit: https://titan.
yishengzhan.
cn/#/public_contribution Please fill in the real information according to the call page*"The medical community" strives to publish the content professional and reliable, but does not promise the accuracy of the content; Relevant parties are requested to check
separately when adopting or using it as a basis for decision-making.
