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Definition, Classification and Diagnosis of Diabetes and Other Dysglycemic Categories

Canadian Diabetes Association Clinical Practice Guidelines Expert Committee
Canadian Journal of Diabetes. December, 2003, Volume 27; Supp 2.
Download complete guidelines

( Canadian Diabetes Association Clinical Practice Guidelines Expert Committee [1] ).

According to the Canadian Diabetes Association (CDA) up to 2.7% of the general adult population have been undiagnosed with Type 2 diabetes [2] . Although the relatively low prevalence of diabetes in the general population may not justify mass screening, certain individuals with increased risk for developing Type 2 diabetes should be screened. Risk factors for Type 2 diabetes includes the following:

Table1. Risk Factors For Type 2 Diabetes*

  • Age 40 years or older
  • First degree relative with diabetes
  • Member of high risk population (e.g. people of Aboriginal, Hispanic, South Asian, Asian or African descent)
  • History of impaired glucose tolerance or impaired fasting glucose
  • Presence of complications associated with diabetes
  • Vascular disease
  • History of gestational diabetes
  • History of delivery of a macrosomic infant
  • Hypertension
  • Dyslipidemia
  • Overweight
  • Abdominal obesity
  • Polycystic ovarian syndrome
  • Acanthosis nigricans
  • Schizophrenia

Are you at risk? (PDF)

Approximately 80% of individuals with diabetes will die as a result of a vascular event [3] . In an effort to mitigate cardiovascular disease risk, there is a need to assess and aggressively manage cardiovascular risk factors in individuals with diabetes, and also screen individuals at high risk for cardiovascular disease for diabetes. The CDA suggests the following screening for Type 2 diabetes, impaired fasting glucose and impaired glucose tolerance:

Screening for Type 2 Diabetes, IFG & IGT [4]

Classification of Diabetes

  • Type 1 Diabetes

Encompasses diabetes that is primarily a result of pancreatic beta cell destruction and that is prone to ketoacidosis. This form includes cases due to an autoimmune process and those for which the etiology of beta cell destruction is unknown
  • Type 2 Diabetes

May range from predominant insulin resistance with relative insulin deficiency to a predominant secretary defect with insulin resistance
  • Gestational Diabetes

Refers to glucose intolerance with first onset or recognition during pregnancy
  • A wide variety of relatively uncommon conditions are listed under “other specific types. These consist mainly of specific genetically defined forms of diabetes or diabetes associated with other disease or drug use.

Diagnosis of Diabetes

1 or

Fasting Plasma Glucose > 7.0mmol/L

(Fasting = no caloric intake for at least 8 hours)

2 or

Casual Plasma Glucose > 11.1mmol/L + symptoms of diabetes

(Casual = any time of day, without regard to the interval since the last meal. Classic symptoms of diabetes = polyuria, polydipsia and unexplained weight loss).

3

2 – hour Plasma Glucose in a 75 gram Oral Glucose Tolerance Test > 11.1/mmol/L

A confirmatory laboratory glucose test (on 1, 2, or 3 above) must be done in all cases on another day in the absence of unequivocal hyperglycemia accompanied by acute metabolic decomposition.

Plasma Glucose Levels for Diagnosis of Impaired Fasting Glucose (IFG), Impaired Glucose Tolerance (IGT) and Diabetes

FPG (mmol/L)

2hPG in a 75g OGTT (mmol/L)

IFG

6.1-6.9

-

NA

IFG (isolated)

6.1-6.9

and

<7.8

IGT (isolated)

<6.1

and

7.8-11.0

IFG and IGT

6.1 – 6.9

and

7.8 – 11.0

Diabetes

> 7.0

or

> 11.1

The CDA website is found here . The goal of the CDA web site is to become THE online resource for people with, and affected by, diabetes and for healthcare professionals treating those affected by the disease. Several excellent resources are available on this web site for individuals with diabetes, and for health care professionals.

[1] Canadian Journal of Diabetes. December, 2003, Volume 27; Supp 2. The complete guidelines published by CDA are available at The complete guidelines published by the CDA are available at http://www.diabetes.ca/cpg2003/chapters.aspx

[2] Harris et al, Diabetes Care. 1998; 21:518-524.

[3] Barrett-Connor E., & Pyorala, K. in The Epidemiology of Diabetes Mellitus: An International Perspective, 2001: 301-319.

[4] Abbreviations:
2hPG = 2-hour plasma glucose
FPG = fasting plasma glucose
IFG = impaired fasting glucose
IGT = impaired glucose tolerance
NA = not applicable
OGTT = oral glucose tolerance test
PG = plasma glucose

 

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