As we all know, the terrible thing about diabetes is not only that blood sugar is high, but that it is followed by damage to multiple organs such as heart, brain, kidney, eye, and nerves.
Therefore, when going to the hospital to see diabetes, in addition to a clear diagnosis, further screening should be carried out to see if there are various acute and chronic complications caused by diabetes. How severe is the condition?
Only by thoroughly understanding the diagnosis, classification and complications of diabetes can we give targeted treatment in a targeted manner.
So, what tests should diabetics do?
Tests related to glucose metabolism disorders
blood sugar
It mainly includes fasting and blood glucose 2 hours after meals. Blood glucose is the gold standard for diagnosing diabetes, and according to the World Health Organization (WHO), the blood glucose standard for diabetes diagnosis is fasting blood glucose ≥7.0 mmol/L and/or 11.1 mmol/L≥ for 2 hours after a meal.
Precautions for diagnosing diabetes
1. It is venous plasma blood glucose that must be measured, not peripheral capillary whole blood glucose;
2. Fasting blood glucose normal can not rule out diabetes, because early diabetes is often the first to manifest as postprandial blood sugar rise and fasting blood glucose can be normal, if only fasting blood glucose is measured, it is easy to miss early diabetes diagnosis;
3. Urine glucose results are affected by the patient's renal glucose threshold, which is not completely consistent with blood glucose, and positive urine glucose can only be used as a diagnostic clue for diabetes, not as a diagnostic basis, and cannot be confirmed or excluded based on positive or negative urine glucose;
4. The diagnosis of diabetes must exclude various stress states such as fever, infection, and acute cardiovascular and cerebrovascular events.
Oral glucose tolerance test (OGTT)
This test is a confirmatory test for diabetes. When a patient's blood glucose is slightly higher than that of a healthy person on an empty stomach or after a meal, but has not yet met the diagnostic criteria for diabetes, an OGTT test is needed to determine whether the patient has diabetes.
Specific test steps
Measure fasting blood glucose first, then drink sugar water containing 75g of glucose, start timing from the first sip, half an hour, 1 hour, 2 hours and 3 hours to detect blood glucose, see the patient's sugar load after the blood glucose change, in order to determine whether there is diabetes.
OGTT test considerations
1. The daily intake of carbohydrates should not be less than 300 grams in the 3 days before the test, and excessive diet restrictions can reduce glucose tolerance and false positives;
2. A few days before the test, all drugs that may affect glucose metabolism should be discontinued, such as glucocorticoids, powerful diuretics, etc.;
3. Avoid doing glucose tolerance tests in stressful states, because stress states such as fever, infection, surgery, acute myocardial infarction, and stroke will cause blood sugar to rise, making the results false positive;
4. After 10 o'clock in the evening before doing OGTT, patients need to fast (Note: drinking water in moderation) and ensure an empty stomach for 8 to 12 hours to obtain accurate glucose tolerance test data.
Those who cannot tolerate this test can choose the steamed bun meal test and replace the sugar water containing 75 g of glucose with a steamed bun made of 100 g of flour.
Glycosylated hemoglobin (HbA1c)
HbA1c is the product of glucose binding to hemoglobin, which is not affected by some accidental factors and can reflect the average blood glucose level of the patient in the previous 2 to 3 months.
HbA1c has long been an important indicator of patients' long-term glycemic control, and today, the latest China Guidelines for the Prevention and Treatment of Type 2 Diabetes (2020 Edition) recommends that HbA1c ≥ 6.5% be included in the diagnosis of diabetes.
Precautions
1. HbA1c is not an exact blood glucose value, it represents the percentage of glycosylated hemoglobin in total hemoglobin, the normal range is 4 to 6%;
2. HbA1c reflects the average blood glucose over a period of time, can not reflect blood glucose fluctuations, two HbA1c-like patients, their blood glucose fluctuations can be very different.
Islet function assay
This test determines the secretion level of insulin and C peptide at various time points (0.5h, 1h, 2h, 3h) on the patient's fasting and after meals, to understand the degree of failure of the patient's islet function, and to help determine the clinical classification of diabetes. The specific test steps are the same as the glucose tolerance test (OGTT test).
Diabetic autoantibody test
It mainly includes glutamate decarboxylase antibody (GADA), insulin autoantibody (IAA), islet cell antibody (ICA), etc., of which GADA appears earliest and lasts in the blood, and has the greatest diagnostic value. This test is mainly used for clinical typing of diabetes mellitus, and patients with type 1 tend to have positive antibodies and no type 2.
Glucose within target range time (TIR)
TIR refers to the duration or percentage of glucose in the target range during the 24-hour period. The blood glucose range of TIR in adult diabetes mellitus is generally defined as 3.9 to 10.0 mmol/L.
As a new indicator of blood glucose measurement, TIR can more fully reflect the patient's blood glucose fluctuations and control levels, help guide the fine adjustment of blood sugar, and can also be used as an evaluation index for chronic complications of diabetes, which is an important supplement to glycosylated hemoglobin.
Tests related to complications (or comorbidities).
The biggest harm of diabetes is not high blood sugar, but the various acute and chronic complications caused by it. Therefore, after the diagnosis of diabetes, in addition to some routine biochemical tests (such as three routines, liver function, kidney function, blood lipids, electrolytes, etc.), it is also necessary to do screening for complications (or comorbidities), which mainly include:
Urine test
It mainly includes urinalysis and urinary microalbumin.
Urinalysis
Attention should be paid to urine glucose, urine protein, urine ketone bodies, urine leukocytes and other indicators, and the patient should be preliminarily judged whether there is a urinary tract infection, whether there is kidney lesions or ketoacidosis.
Urine microalbumin
It is mainly to check the ratio of urine albumin to creatinine in 24-hour urine microalbumin quantification or random urine, and this test is mainly used to screen for early diabetic nephropathy.
Diabetic nephropathy is usually divided into 5 stages, in the early stage of diabetic nephropathy (stage 3), patients often have no self-conscious symptoms, but only appear as microalbuminuria, if you can find in time at this stage, early intervention, the disease can mostly be reversed, and once this stage has passed, the condition will be irreversible.
Liver and kidney function
Understand whether the patient's liver and kidney function is problematic, observe whether the drugs used have an impact on the liver and kidneys, and guide the clinical scientific selection of drugs, because some oral hypoglycemic drugs are contraindicated in the use of liver and kidney insufficiency. In addition, we can calculate the glomerular filtration rate (eGFR) based on the serum creatinine value to assess the patient's renal function.
Blood lipids, blood pressure
Hypertension and lipid metabolism disorders are important risk factors for cardiovascular and cerebrovascular diseases, and must be monitored and strictly controlled. Ordinary diabetic patients require blood pressure to be controlled below 130/80mmHg, and for those who have developed proteinuria, blood pressure is required to be controlled below 125/75mmHg.
Ordinary diabetic patients require that low-density lipoprotein cholesterol (LDL-C) be controlled below 2.6mmol/L, and patients with diabetes mellitus with cardiovascular and cerebrovascular diseases require that LDL-C be controlled below 1.8mmol/L.
Other biochemical indicators
Including blood glucose, electrolytes, blood ketone bodies, blood lactate, carbon dioxide binding, blood PH value, etc., it is mainly used to check for acute complications of diabetes such as diabetic ketoacidosis, non-keto hyperosmolar coma, and lactic acidosis.
Tumor markers
In recent years, studies have found that diabetes and tumors are very closely related, and the risk of liver cancer, pancreatic cancer, colorectal cancer, breast cancer and other tumors in diabetic populations is significantly higher than that of the general population, and it is recommended that diabetes routinely check tumor markers, which is usually ignored.
Body Mass Index (BMI)
BMI = weight (kg) / height 2 (m2). The normal standard is
Electrocardiogram and cardiac ultrasound
EcG can reflect the presence or absence of arrhythmias and cardiac ischemia, and cardiac ultrasound can reveal abnormalities in cardiac structure and cardiac function. These tests help to detect cardiovascular complications in patients early.
It should be reminded that diabetics due to sensory nerve damage, in the occurrence of angina, acute myocardial infarction, often do not have chest pain and other typical symptoms, it is easy to be missed and delayed diagnosis and treatment, therefore, must not ignore this aspect of screening.
Eye examination
It is known that patients have ocular complications of diabetes such as ignoring encephary disease, cataracts, and glaucoma. It should be reminded that diabetic retinopathy (DR) often has no symptoms in the early stages, and if you wait until the vision is significantly reduced to check the fundus, the condition is often not early, missing the best time for treatment. Therefore, at the beginning of the diagnosis of diabetes, the fundus should be examined for early detection and treatment.
Vascular ultrasound and ankle brachial index (ABI) determination
Lower extremity vascular ultrasound is mainly used to understand the extent and severity of vascular lesions in the lower extremities.
The ABI represents the ratio of ankle artery systolic blood pressure to humeral artery systolic blood pressure, and the normal value should be greater than 0.9. If it is less than 0.9, it indicates that the arterial blood vessels of the lower extremities are hardened, and if it is less than 0.6, it indicates that the vascular lesions of the lower extremities are more serious.
The above two tests are mainly used for the screening and evaluation of vascular lesions of the lower extremities.
Neuromyography
With neuromyography, diabetic peripheral neuropathy can be detected early, and early intervention is expected to reverse the lesion. A simpler approach can also be taken – a nylon wire haptic examination, which stimulates the patient's foot with a single 10 grams of single nylon filament to see if the patient has paresthesias.
Note: Early symptoms of diabetic peripheral neuropathy (DPN) are often inconspicuous, and when typical symptoms such as numbness, pain sensation, hypoesthesia, or disappearance occur, the lesion is not early, so early screening is very important.
Bone density (BMD) test
Compared with the general population, diabetics are more likely to develop osteoporosis, and many diabetics often have low back pain and limb weakness. By examining bone density (BMD), it is possible to know whether the patient has osteopenia and osteoporosis for early intervention.
Imaging studies
Chest X-ray or CT scan
Find out if the patient is having a concomitant lung infection or tuberculosis.
Abdominal ultrasound examination
See if the patient has fatty liver, cholelithiasis, or other chronic liver disease.
Oral disease screening
Check for tooth decay, gingivitis, periodontal abscess, alveolar bone resorption, loose tooth loss, oral mold infection, etc.
Depression screening
Many diabetics suffer from pessimism, anxiety, depression and other bad emotions for a long time, and are depressed and unable to extricate themselves. According to the survey, the incidence of depression in diabetics is about 10%. Through special psychological tests, patients' psychological problems can be detected early and intervened in time.
It should be reminded that diabetes is a psychosomatic disease, stable mood and good mentality are very important for the smooth control of blood sugar, and clinicians often pay attention to the patient's physical problems, and the psychological problems are often not enough, and the latter is also very important for the patient's quality of life and disease prognosis.
How to schedule the frequency of inspections
Regular check-ups for diabetics and frequency
Source: Lilac Garden Endocrine Time
Edited by: Yeah Reviewer: Xiao Ran