Screening for Diabetes Mellitus in Elderly.pptx

Guidelines for screening for Diabetes, including screening for the disease as well as its complications with focus on elderly.

1. Diabetes screening in elderly Akash Dasgupta 1 st year JR, MD CM 1

2. Screening modalities Fasting Plasma Glucose Estimation 2 Hour Plasma Glucose Estimation during OGTT HbA1c Level Assay Random Plasma Glucose Estimation 2

3. Who should be screened ? ADA recommends screening of all adults beyond 35 years of age; so Every Elderly Person has to be screened for Diabetes. 3 How frequently should we screen ? After first screening, For non-diabetic individuals, Screening should be done every 3 years For pre-diabetic individuals, Screening should be done every year

4. Diagnose as DIABETES Source : Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes—2022. Diabetes Care December 2021, Vol.45, S8-S16. doi : https://doi.org/10.2337/dc22-S001

5. PREDIABETES Impaired Fasting Glucose (IFG) : Fasting Plasma Glucose between 100mg/dl to 125 mg/dl Impaired Glucose Tolerance (IGT) : 2 Hr Plasma Glucose during 75gm OGTT between 140mg/dl to 199mg/dl HbA1c between 5.7% to 6.4% ( 39-47mmol/ mol 5

6. Points to consider HbA1c estimation should be done by a method which is NGSP certified or Standardized to DCCT assay to avoid misdiagnosis with the designated cut-offs If there is discordance between the Blood Glucose estimations and the HbA1c levels, the test with the higher value has to be repeated again to confirm diagnosis. Prior to using OGTT as a screening modality, there should be adequate Carbohydrate intake ( at least 150mg/day) for the previous three days. In certain specific conditions (hemoglobinopathies) with altered relationship between A1c and Glycemia, only plasma Glucose levels should be used for screening. 6

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8. Screening for complications Patients >65 years : screen for mild cognitive impairment/ dementia @ first visit/ annually All patients screened for Hypertension @every visit and Lipid profile @annualy to look for associated cardiovascular disease All patients to be screened annually for Urinary Albumin ( Spot urine Albumin to Creatinine ratio) and estimated Glomerular Filtration rate All patients should be screened for Retinopathy through comprehensive Dilated Eye Examination by Ophthalmologist at the time of diagnosis, every 1-2 years Screen for the risk of Episodes of Hypoglycemia by interviewing Patient and Caregiver regarding ( i ) Practice of fasting/skipping meals (ii) Taking medications irregularly/multiple times. 8

9. references 1. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes—2022. Diabetes Care December 2021, Vol.45, S8-S16. doi : https://doi.org/10.2337/dc22-S001 2. Older Adults: Standards of Medical Care in Diabetes—2022 Diabetes Care 2022;45(Suppl. 1):S195–S207 | https://doi.org/10.2337/dc22-S013 3. Chronic Kidney Disease and Risk Management: Standards of Medical Care in Diabetes—2022 Diabetes Care 2022;45(Suppl. 1):S175–S184 | https://doi.org/10.2337/dc22-S011 4. Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes—2022 Diabetes Care 2022;45(Suppl. 1):S144–S174 | https://doi.org/10.2337/dc22-S010 5. Retinopathy, Neuropathy, and Foot Care: Standards of Medical Care in Diabetes—2022 Diabetes Care 2022;45(Suppl. 1):S185–S194 | https://doi.org/10.2337/dc22-S012 9