Importance of Screening For Diabetes and it's Associated Complications

Diabetes has become a major health threat to the whole world; Indeed, the greatest increase will be contributed by India, which has already been declared by the World Health Organization (WHO) as the country with the largest number of diabetics in the world. Diabetes is frequently not diagnosed until complications appear, and approximately one third of all people with diabetes may be undiagnosed, although diagnosed many people are not aware of their condition.

Late detection of diabetes often means that at the time of diagnosis complications have already damaged the eyes, kidneys and nerves. These complications are costly in the physical, financial and psychosocial sense. Early detection and treatment of diabetes may not only improve glycemic control, but also improves blood pressure and lipids.
Who should be screened? In general all adults should be screened at regular intervals

  o Family history of diabetes (ie, parents or siblings with diabetes) 
o Overweight (Body Mass Index> 25 kg / m2)
o Age> 45 years
o Previous identified impaired fasting glucose (IFG) or impaired glucose tolerance (IGT)
o Hypertension (> 140/90 mmHg)
o Hyperlipidemia (HDL - 250 mg / dL or both)
o History of gestational diabetes or delivery of a baby over 9 lb (4.1 kg) (ADA-Diabetes Care 2004)

What are the Screening test for Diabetes

Fasting Plasma Glucose: The fasting plasma glucose (FPG) test is the standard test for diabetes. It is a simple blood test taken after eight hours of fasting. The FPG test is not always reliable, so a repeat test is recommended if the initial test suggests the presence of diabetes.

Oral Glucose Tolerance Test: The glucose tolerance test may be more accurate than the FPG in certain groups (eg, women with a history of gestational diabetes). The test uses the following procedures: I) after an overnight fast Fasting Plasma Glucose test is performed. ii) After this test a person receives 75 g of glucose (100 g for pregnant women) blood samples are taken every half an hour {(fast-30mts-60mts-90mts-120mts- (five times)} to measure the blood glucose. It not only helps in detecting diabetes but also help to detect the pre-diabetic status, Impaired Fasting Glucose (IFG) & Impaired Glucose
Tolerance (IGT))

Is it important to detect pre-diabetic stage? Yes! Because it is "preventable"
Criteria for the diagnosis of diabetes mellitus


Symptoms of diabetes + Random plasma glucose o Blood pressure check up, regular at every visit for Hypertension (high blood pressure) – should be 40
o An electrocardiogram (ECG), that provides information about the status of heart
o Chest X ray, information about the lungs and shape of the heart and vascular system (aorta and blood vessels)
o Carotid Intima-media Thickness (IMT), marker of early atherosclerosis

Diabetic Nephropathy (Kidney Damage): Person with diabetes are several times more prone to kidney disease than the general population. The earliest manifestation of kidney damage is microalbuminuria, (tiny amounts of protein called aluminum are found in the urine). Symptoms include Protein in the urine, High blood pressure, burning during urination, frequent urination, puffiness and swelling around the eyes, hand & feet, excessive itching, nausea, vomiting & weakness.

About 20% of type 2 patients show evidence of microalbuminuria upon diagnosis of diabetes, however, only a small percentage of type-2 diabetics usually develops kidney disease. Microalbuminuria typically shows up in type 2 diabetics who have high blood pressure. Normal: 15yrs will develop diabetic retinopathy in their lifetime.
Who are more prone to Diabetic retinopathy? : Uncontrolled blood sugar, longstanding diabetes, Hypertension with diabetes & Genetic predisposition.

What are the stages of retinopathy? : Mild non proliferative diabetic retinopathy (NPDR), Moderate-non proliferative diabetic retinopathy, severe retinopathy, Maculopathy and Proliferative diabetic retinopathy. Treatment: Retinopathy can be treated through laser photocoagulation. Screening test: Patients with diabetes should have an initial dilated and comprehensive eye examination by an ophthalmologist or optometrist right from the day of diagnosis of diabetes and every year thereafter. Early detection, timely treatment, appropriate screening and care reduce the risk of vision loss & 90% of diabetes related blindness.

All patients should be regularly screened for risk factors and encouraged at each health care visit to pursue a healthy lifestyle that includes a healthy diet, adequate exercise, weight control and stress reduction. 'Try for good control to be sure, but do not try for perfection. Perfection lasts for a moment, and diabetes lasts a lifetime '. The main theme is to be focus on to 'live a Healthy Life Quite Diabetes'.