High risk criteria for asymptomatic diabetes screening
3 yearly HbA1c or FBGL screening:
- Assessed by AUSDRISK >12
- >40 + overweight
- 20-40yo + overweight + clinical insulin resistance, lipids, HTN
- Previous IFG
- 1st degree relative
- PCOS
- Hx GDM
- Antipsychotics
- Ethnicties - latin american, middle eastern, north african, SE asian
Annual screening for ATSI/moari/pacific > 18yo
Screening ATSI > 10yo if risk factor
- Clinical insulin resistance
- Maternal GDM
- 1st degree relative
Flow chart for investigation of asymptomatic T2DM screening with FBGL
FBGL
< 5.5 normal
5.5 - 6.9 - possible - OGTT
> 7 - likely diabetes, repeat to confirm
Flow chart for investigation of asymptomatic T2DM screening with HbA1c
HbA1c
<6% normal
6 - 6.4%
Possible - retest in 1 year
> 6.5%
Likely - repeat to confirm
OGTT results following asymptomatic screening (when FBGL screen 5.5 - 6.9)
Impaired levels - retest in 1 year
FBGL 6.1 - 6.9
2hr 7.8 - 11.1
Diagnostic
FBGL > 7
2hr > 11.1
Diagnosis of T2DM
- FBGL
- HbA1c
- OGTT
- Symptomatic vs asymptomatic
Asymptomatic
FBGL >7 (repeated)
HbA1c > 6.5 (repeated)
Random BGL > 11.1 (repeated)
OGTT
FBGL >7
2hr > 11.1
Symptomatic + FBGL > 7 or HbA1c > 6.5
Interpreting female hormonal panel
- What pattern should see estradiol, progesterone, LH in follicular phase
- When best to measure hormonal panel
Morning test in first week of cycle (follicular phase)
If doing for androgen interpretation for PCOS should be off oestrogens for 3 months
Follicular phase
- Estradiol should be higher than progesterone
- LH and progesterone should be similar and low (in Luteal phase progesterone much higher than LH, which only peaks with ovulation)
