Diabetes is a common disease that has an asymptomatic stage that may be present for up to seven years before diagnosis. People who need to be screened for diabetes are:
- Individuals having symptoms described in the earlier two columns.
- All pre-diabetics.
- All high risk individuals
Indian Diabetic Risk Score (IDRS) of more than 60; age more than 45; overweight with BMI greater than 23; central obesity; sedentary lifestyle; positive family history; high BP; high cholesterol.
- Women with history of gestational diabetes (diabetes detected during pregnancy).
- Women who have delivered baby of more than 4.5 kg.
- Women with PCOD (polycystic ovarian disease).
- Individuals on certain drugs like steroids & diuretics, etc.
Screening is normally done with random blood glucose estimation. If sugar levels are clearly falling under the diagnostic criteria for diabetes, the management strategies can be started. In the absence of unequivocal high levels, the values should be confirmed by repeat testing on a separate day.
WHO, however, recommends the use of oral glucose tolerance test (testing of blood glucose at 0, ½, 1 and 2 hours after taking 75 gm of glucose powder) to confirm the diagnosis of diabetes in asymptomatic individual.
Recently another test HbA1c (glycated haemoglobin) has gained widespread acceptance. This is an index of glucose control over the preceding three months. It is a good test to monitor the control and efficacy of medication. HbA1c being used as test of diagnosis is not very practical in India due to economic considerations as well as reservations about standardisation of test.
(Dr Ajay Agarwal is a consultant family physician, with several papers and books on health issues to his credit. He is also the recipient of Lt. Governor of Delhi’s ‘Distinguished Service Award’).
Health Matters is Dr Ajay Agarwal’s attempt to demystify diabetes and make it manageable. Send in all your queries to firstname.lastname@example.org. Dr Agarwal will answer them in next week’s post.