Assessment Of Diabetesrelated Symptoms

The clinical diagnosis of diabetes is often prompted by symptoms such as polyuria and polydipsia, recurrent infections, unexplained weight loss and, in severe cases, drowsiness and coma. In such cases a single blood glucose determination in excess of the diagnostic values indicated in Figure 2.2 (black zone) establishes the diagnosis. Figure 2.2 also defines levels of blood glucose below which a diagnosis of diabetes is unlikely in non-pregnant individuals. These criteria are unchanged from the 1985 WHO report7. For clinical purposes, an OGTT to establish diagnostic status need only be considered if casual blood glucose values lie in the uncertain range (i.e. between the levels that establish or exclude diabetes) and fasting blood glucose levels are below those which establish the diagnosis of diabetes.

Whole blood

Plasma

Venous Capillary Venous Capillary

Whole blood

Plasma

Venous Capillary Venous Capillary

Diabetes mellitus likely

Diabetes mellitus uncertain

Diabetes mellitus likely

Diabetes mellitus uncertain

Diabetes mellitus unlikely

Figure 2.2. Unstandardised (casual, random) blood glucose values in the diagnosis of diabetes in mmol/l (mg/dl). Taken from the 1999 WHO Study Group Report13.

However, data from population-based studies show that symptoms of hyper-glycaemia (such as thirst and polyuria) have a poor sensitivity and specificity for diabetes48. Therefore, it is not recommended that symptoms form part of the screening process, although it remains good clinical practice to look for diabetes in someone presenting with typical symptoms of hyperglycaemia.

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