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.
 Â
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. Â
Asymptomatic children and adolescents at risk of DM should also undergo active screening, which should begin at age 10 years or puberty.
Â
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).
Â
2. People with prediabetes (AGJ, TSG or HbA1c: 5.7 -6.4%) will be tested annually
Â
3. People with a previous diagnosis of GDI will be tested at least every 3 years throughout Life
Â
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.
Â
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).
Â
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