CATEGORY 2: Asymptomatic && RISK SCORE >= 7
hasDisease = Diabete = RPG >= 200 && Hyperglycemia
hasDisease = Diabete = RPG >=200 && Hyperglycemic_Crisis
CASE 2: Risk10YearsDiabetes = Slightly elevated
hasDisease = Prediabetes = 140 <= 2hOGTT <=199
hasDisease = Prediabetes = 100<= FPG <= 125
hasDisease = Prediabetes = 5.7 <= HBA1C =< 6.4
The patient has a risk of T2DM, it should be investigated whether she/he has Diabetes or Prediabetes.
The patient should be examined by a specialist.
FPG, RPG, and HbA1c tests can be applied for the patient, or apply OGTT sugar load test.
If results of tests are normal, the tests should be repeated at a minimum of 3-year intervals, with consideration of more frequent testing depending on initial results and risk status.
According to the recommendation of the ADA (American Diabetes Association), it is recommended to start screening in individuals after the age of 35. If the patient is over the age of 35, DM screening should be started immediately.
Diet, physical activity, and behavioral counseling is recommended for all patients with BMI ≥ 25.
Diet, physical activity, and behavioral therapy to achieve and maintain weight loss is recommended for both people with T2DM and Overweight or Obesity.
The patient may need to take medication. Pharmacotherapy is recommended for the patients with BMI ≥ 27.
Metabolic surgery is medically appropriate for patients with BMI ≥ 30.
Height and weight should be measured and used to calculate BMI annually, or more frequently when appropriate (overweight: BMI is 25–29.9 kg/m2; obesity class I: BMI is 30–34.9 kg/m2; obesity class II: BMI is 35–39.9 kg/m2; obesity class III: BMI is 40 kg/m2).
The patient has DM due to one/few of the FPG, RPG, OGTT, and HbA1c tests is/are found outside of its normal limits.
The patient should take professional support from a specialist in order to start the most appropriate treatment (diet, physical activity, and behavioral therapy, pharmacotherapy, metabolic surgery).
The patient needs to be examined for complications of DM. Assessing risk of diabetes complications includes atherosclerotic cardiovascular disease and heart failure history, chronic kidney disease, hypoglycemia risk, retinopathy neuropathy.
A complete medical evaluation should be performed at the initial visit to; confirm the diagnosis and classify diabetes, evaluate for diabetes complications and potential comorbid conditions, review previous treatment and risk factor control in patients with established diabetes, begin patient engagement in the formulation of a care management plan and develop a plan for continuing care.
The patient needs to start proper diet and exercise program.
The patient needs to be assessed by a dietitian immediately.
Patients with T1DM should be screened for other autoimmune diseases soon after diagnosis and periodically thereafter.
Patients with T1DM should use insulin therapy.
The risk of diabetes for the patient is high-- Prediabetes.
If HbA1c value is between 5.7 - 6.4%, the patient is in the prediabetes category. Therefore, more frequent screening tests should be performed. Patients with suspected prediabetes, their HbA1c, IGT, and IFG values should be scanned annually.
It is necessary for the patient to define a proper treatment plan immediately.
It is recommended that the patient follow a regular sleep and nutrition program. Therefore, a professional dietitian is needed to be assign to the patient.
The patient should be informed that daily physical activity is required to prevent the risk of DM. (It is essential that the patient exercises approximately 1 hour a day to reduce the risk of complications, , or at least 200– 300 mins/week).
The patient may need supportive pretreatment due to the risk of DM for the patient is much higher.
If the patient's BMI ≥ 25 kg/m2, the risk of diabetes of the patient is very high. For the patient to have a BMI ≥ 25, he/she must lose at least %7 of his/her body weight. Additional weight loss usually results in further improvements in control. A professional diet plan that will provide the patient with appropriate target weight loss should be initiated immediately.
Significant weight loss can be attained with lifestyle programs that achieve a 500–750 kcal/day energy deficit, which in most cases is approximately 1,200–1,500 kcal/day for women and 1,500–1,800 kcal/day for men, adjusted for the individual’s baseline body weight.
Such interventions should include a high frequency of counseling (≥16 sessions in 6 months) and focus on dietary changes, physical activity, and behavioral strategies to achieve a 500–750 kcal/day energy deficit.
Behavioral changes that create an energy deficit, regardless of macronutrient composition, will result in weight loss. Dietary recommendations should be individualized to the patient’s preferences and nutritional needs.
For those who achieve weight loss goals, long-term (≥1 year) weight maintenance programs are recommended when available. Such programs should, at minimum, provide monthly contact and support, recommend ongoing monitoring of body weight (weekly or more frequently) and other self-monitoring strategies, and encourage regular physical activity. Daily physical activity is required to prevent the risk of DM (at least 200– 300 min/week).
A woman who has been diagnosed with Gestational DM, even if she does not have any complaints or symptoms, should have the FPG, RPG, OGTT, or HbA1c tests at least once every 3 years.