Silvia Dewald, Family Doctor from Braila, Romania was invited to the final D-PATH conference that took place in Braila 7-9 June 2023. She delivered a complex lecture on a series of issues family doctors come over while seeing their patients with diabetes or not. She approached asymptomatic adults, adolescents and children.
Screening for DM in asymptomatic adults is recommended by the ADA in people with overweight or obesity (body mass index (BMI) ≥25 kg/m3) who have one or more risk factors for DM. People with pre-diabetes will be retested annually, and those with gestational diabetes mellitus (GDI) every 3 years, throughout life (6). For all other adults, screening will begin at age 45.
Asymptomatic children and adolescents at risk of DM should also undergo active screening, which should begin at age 10 years or puberty.
ADA criteria for testing asymptomatic adults
Testing should be performed in all overweight/obese adults (BMI ≥ 25 kg/m2) who have additional risk factors for DM:
· a first-degree relative with DM;
· a high-risk ethnic/racial group (African Americans, Hispanics, Native Americans, etc.);
· History of cardiovascular disease;
· hypertension (≥140/90 mmHg or antihypertensive therapy);
· HDLC <35 mg/dl (0.9 mmol/l) and/or triglycerides >250 mg/dl (2.82 mmol/l);
· sedentary lifestyle;
· women with polycystic ovary syndrome;
· Other clinical conditions associated with insulin resistance (e.g. Acantosis nigricans).
2. People with prediabetes (AGJ, TSG or HbA1c: 5.7 -6.4%) will be tested annually
3. People with a previous diagnosis of GDI will be tested at least every 3 years throughout Life
4. In all other people, screening begins at age 45.
Asymptomatic children and adolescents at risk of DM should also undergo active screening, which should begin at age 10 years or puberty.
ADA criteria for testing asymptomatic children and adolescents
Testing should be performed in all asymptomatic children and adolescents who are overweight and have at least 1 additional risk factor:
· a maternal history of DM or GAI during pregnancy;
· a first- or second-degree relative with type 2 diabetes;
· a high-risk racial or ethnic group (African Americans, Hispanics, Native Americans, etc.);
· signs of insulin resistance or clinical conditions associated with insulin resistance (e.g. acanthosis nigricans, hypertension, dyslipidaemia, polycystic ovary syndrome or low birth weight for gestational age).
1. American Diabetes Association. Standards of Medical Care in Diabetes - 2019. Diabetes Care 2019; 42 (Suppl. 1).
2. Davies MJ, D'Alessio DA, Fradkin J, et al. Management of hyperglycemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2018; 41 (12): 2669- 2701
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