Interpretation of 2024 American Diabetes Association’s Standards of Care in Diabetes — diabetes diagnosis and classification

doi:10.16150/j.1671-2870.2024.05.002

Abstract

Abstract:

Diabetes is a common chronic disease, which has caused a significant health and economic burden worldwide. Diabetes is highly heterogeneous. Accurate diagnosis and classification are the premises to achieve standardized and accurate treatment of diabetes and improve the clinical outcomes of patients. Recently, the American Diabetes Association (ADA) issued the 2024 Standards of Medical Care in Diabetes. In the chapter on diabetes diagnosis and classification, the latest developments have been taken into account, with recommended approaches for the differential diagnosis of atypical diabetes, screening, diagnosis, and follow-up processes of different types of diabetes. This article interprets this section of the guidelines to provide a reference for healthcare professionals in the endocrine field in China for the accurate diagnosis, classification, and individualized treatment of diabetes.

Key words: Diabetes, Diagnosis, Classification, American Diabetes Association

CLC Number:

R587.1
R446

LI Yanbing. Interpretation of 2024 American Diabetes Association’s Standards of Care in Diabetes — diabetes diagnosis and classification[J]. Journal of Diagnostics Concepts & Practice, 2024, 23(05): 467-473.

Figures/Tables 6

Table 1

Figure 1

Table 2

Table 3

Table 4

Table 5

References 35

[1]	American Diabetes Association Professional Practice Committee. 2. Diagnosis and classification of diabetes: standards of care in diabetes-2024[J]. Diabetes Care, 2024, 47(Suppl 1):S20-S42. doi: 10.2337/dc24-S002 pmid: 38078589
[2]	MEIJNIKMAN A S, DE BLOCK C E M, DIRINCK E, et al. Not performing an OGTT results in significant underdiagnosis of (pre)diabetes in a high risk adult Caucasian population[J]. Int J Obes (Lond), 2017, 41(11):1615-1620.
[3]	HOLT R I G, DEVRIES J H, HESS-FISCHL A, et al. The management of type 1 diabetes in adults. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)[J]. Diabetes Care, 2021, 44(11):2589-2625. doi: 10.2337/dci21-0043 pmid: 34593612
[4]	INSEL R A, DUNNE J L, ATKINSON M A, et al. Staging presymptomatic type 1 diabetes: a scientific statement of JDRF, the Endocrine Society, and the American Diabetes Association[J]. Diabetes Care, 2015, 38(10):1964-1974. doi: 10.2337/dc15-1419 pmid: 26404926
[5]	SOSENKO J M, PALMER J P, RAFKIN-MERVIS L, et al. Incident dysglycemia and progression to type 1 diabetes among participants in the Diabetes Prevention Trial-Type 1[J]. Diabetes Care, 2009, 32(9):1603-1607. doi: 10.2337/dc08-2140 pmid: 19487644
[6]	KRISCHER J P. Type 1 Diabetes Trialnet Study Group. The use of intermediate endpoints in the design of type 1 diabetes prevention trials[J]. Diabetologia, 2013, 56(9):1919-1924.
[7]	SMITH C J, ALMODALLAL Y, JATOI A. Rare adverse events with programmed death-1 and programmed death-1 ligand inhibitors: justification and rationale for a systematic review[J]. Curr Oncol Rep, 2021, 23(7):86. doi: 10.1007/s11912-021-01089-9 pmid: 34037893
[8]	ZHAO Z, WANG X, BAO X Q, et al. Autoimmune polyendocrine syndrome induced by immune checkpoint inhibitors: a systematic review[J]. Cancer Immunol Immunother, 2021, 70(6):1527-1540. doi: 10.1007/s00262-020-02699-1 pmid: 33200250
[9]	CHEN X, AFFINATI AH, LEE Y, et al. Immune checkpoint inhibitors and risk of type 1 diabetes[J]. Diabetes Care, 2022, 45(5):1170-1176. doi: 10.2337/dc21-2213 pmid: 35238899
[10]	ARSLANIAN S, BACHA F, GREY M, et al. Evaluation and management of youth-onset type 2 diabetes: a position statement by the american diabetes association[J]. Diabetes Care, 2018, 41(12):2648-2668. doi: 10.2337/dci18-0052 pmid: 30425094
[11]	MANSI I A, SUMITHRAN P, KINAAN M. Risk of diabetes with statins[J]. BMJ, 2023,381:e071727.
[12]	ECKHARDT B J, HOLZMAN R S, KWAN C K, et al. Glycated hemoglobin A(1c) as screening for diabetes mellitus in HIV-infected individuals[J]. AIDS Patient Care STDS, 2012, 26(4):197-201.
[13]	American Diabetes Association, American Psychiatric Association, American Association of Clinical Endocrinologists, et al. Consensus development conference on antipsychotic drugs and obesity and diabetes[J]. Diabetes Care, 2004, 27(2):596-601.
[14]	EWALD N, BRETZEL R G. Diabetes mellitus secondary to pancreatic diseases (type 3c)--are we neglecting an important disease?[J] Eur J Intern Med, 2013, 24(3):203-206. doi: 10.1016/j.ejim.2012.12.017 pmid: 23375619
[15]	HARDT P D, BRENDEL M D, KLOER H U, et al. Is pancreatic diabetes (type 3c diabetes) underdiagnosed and misdiagnosed?[J] Diabetes Care, 2008,31 Suppl 2:S165-169.
[16]	WOODMANSEY C, MCGOVERN A P, MCCULLOUGH K A, et al. Incidence, demographics, and clinical characteristics of diabetes of the exocrine pancreas (Type 3c): a retrospective cohort study[J]. Diabetes Care, 2017, 40(11):1486-1493. doi: 10.2337/dc17-0542 pmid: 28860126
[17]	PETROV M S, BASINA M. Diagnosis Of Endocrine Di-sease: diagnosing and classifying diabetes in diseases of the exocrine pancreas[J]. Eur J Endocrinol, 2021, 184(4):R151-R163.
[18]	MORAN A, PILLAY K, BECKER D, et al. ISPAD clinical practice consensus guidelines 2018: management of cystic fibrosis-related diabetes in children and adolescents[J]. Pediatr Diabetes, 2018,19 Suppl 27:64-74.
[19]	DARUKHANAVALA A, VAN DESSEL F, HO J, et al. Use of hemoglobin A1c to identify dysglycemia in cystic fibrosis[J]. PLoS One, 2021, 16(4):e0250036.
[20]	SHARIF A, HECKING M, DE VRIES A P, et al. Proceedings from an international consensus meeting on posttransplantation diabetes mellitus: recommendations and future directions[J]. Am J Transplant, 2014, 14(9):1992-2000. doi: 10.1111/ajt.12850 pmid: 25307034
[21]	GULSOY KIRNAP N, BOZKUS Y, HABERAL M. Analysis of risk factors for posttransplant diabetes mellitus after kidney transplantation: single-center experience[J]. Exp Clin Transplant, 2020, 18(Suppl 1):36-40. doi: 10.6002/ect.TOND-TDTD2019.O8 pmid: 32008491
[22]	SHARIF A, MOORE R H, BABOOLAL K. The use of oral glucose tolerance tests to risk stratify for new-onset diabetes after transplantation: an underdiagnosed phenomenon[J]. Transplantation, 2006, 82(12):1667-1672. doi: 10.1097/01.tp.0000250924.99855.42 pmid: 17198257
[23]	HECKING M, WERZOWA J, HAIDINGER M, et al. Novel views on new-onset diabetes after transplantation: development, prevention and treatment[J]. Nephrol Dial Transplant, 2013, 28(3):550-566.
[24]	DE FRANCO E, FLANAGAN S E, HOUGHTON J A, et al. The effect of early, comprehensive genomic testing on clinical care in neonatal diabetes: an international cohort study[J]. Lancet, 2015, 386(9997):957-963. doi: 10.1016/S0140-6736(15)60098-8 pmid: 26231457
[25]	TIMSIT J, SAINT-MARTIN C, DUBOIS-LAFORGUE D, et al. Searching for Maturity-onset diabetes of the young (MODY): when and what for?[J] Can J Diabetes, 2016, 40(5):455-461. doi: S1499-2671(15)30008-3 pmid: 27103109
[26]	AWA W L, SCHOBER E, WIEGAND S, et al. Reclassification of diabetes type in pediatric patients initially classified as type 2 diabetes mellitus: 15 years follow-up usi-ng routine data from the German/Austrian DPV database[J]. Diabetes Res Clin Pract, 2011, 94(3):463-467.
[27]	SHIELDS B M, HICKS S, SHEPHERD M H, et al. Maturity-onset diabetes of the young (MODY): how many cases are we missing?[J] Diabetologia, 2010, 53(12):2504-2508. doi: 10.1007/s00125-010-1799-4 pmid: 20499044
[28]	RUBIO-CABEZAS O, HATTERSLEY A T, NJØLSTAD P R, et al. ISPAD clinical practice consensus guidelines 2014. The diagnosis and management of monogenic diabetes in children and adolescents[J]. Pediatr Diabetes, 2014,15 Suppl 20:47-64.
[29]	ZHANG X, GREGG E W, WILLIAMSON D F, et al. A1C level and future risk of diabetes: a systematic review[J]. Diabetes Care, 2010, 33(7):1665-1673. doi: 10.2337/dc09-1939 pmid: 20587727
[30]	BUCHANAN T A, XIANG A, KJOS S L, et al. What is gestational diabetes?[J] Diabetes Care, 2007,30 Suppl 2:S105-111.
[31]	VOUNZOULAKI E, KHUNTI K, ABNER S C, et al. Progression to type 2 diabetes in women with a known history of gestational diabetes: systematic review and meta-analysis[J]. BMJ, 2020,369:m1361.
[32]	World Health Organization. Classification of diabetes mellitus[M]. Geneva: World Health Organization, 2019.
[33]	中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2020年版)[J]. 中华糖尿病杂志, 2021, 13(4):315-409.
	Chinese Diabetes Society. Chinese guidelines for the prevention and treatment of type 2 diabetes (2020 edition)[J]. Chin J Diabetes Mellitus, 2021, 13(4):315-409.
[34]	Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the expert committee on the diagnosis and classification of diabetes mellitus[J]. Diabetes Care, 2003,26 Suppl 1:S5-20.
[35]	BERGMAN M, MANCO M, SATMAN I, et al. International diabetes federation position statement on the 1-hour post-load plasma glucose for the diagnosis of intermediate hyperglycaemia and type 2 diabetes[J]. Diabetes Res Clin Pract, 2024,209:111589.

	1期	2期	3期
特征	自身免疫正常血糖症状前	自身免疫血糖升高症状前	自身免疫显性高血糖症状性
诊断标准	多种胰岛自身抗体阳性；无IGT或IFG	胰岛自身抗体阳性（通常为多种）血糖异常：IFG和（或）IGT FPG 5.6~6.9 mmol/L 2 h PG 7.8~11.0 mmol/L HbA1c 5.7%~6.4%或HbA1c 增加≥10%	自身抗体可能缺失达到糖尿病诊断标准

诊断条件	FPG	1 h PG	2 h PG	3 h PG
一步法：	≥5.1 mmol/L	≥10.0 mmol/L	≥8.5 mmol/L
75 g OGTT
两步法：
50 g GLT（非禁食）		≥7.2/7.5/7.8 mmol/L*
100 g OGTT（禁食）	≥5.3 mmol/L	≥10.0 mmol/L	≥8.6 mmol/L	≥7.8 mmol/L

项目	ADA	WHO/CDS
IFG（FPG）	5.6~6.9 mmol/L (100~125 mg/dL)	6.1~6.9 mmol/L(110~125 mg/dL)且2 h PG<7.8 mmol/L(140 mg/dL)
IGT（OGTT 2 h PG）	7.8~11.0 mmol/L(140~199 mg/dL)	7.8~11.0 mmol/L(140~199 mg/dL)
HbA1c	5.7%~6.4%(39~46 mmol/mol)