Diagnosis and Glycemic Control of Type 1 Diabetes

Jae Hyun Kim

doi:10.4093/jkd.2015.16.2.101

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Kim: Diagnosis and Glycemic Control of Type 1 Diabetes

Focused Issue

J Korean Diabetes 2015;16(2):101-107.

Published online: 10 January 2015

DOI: https://doi.org/10.4093/jkd.2015.16.2.101

Diagnosis and Glycemic Control of Type 1 Diabetes

Jae Hyun Kim

Department of Pediatrics, Inje University Ilsan Paik Hospital, Goyang, Korea

Corresponding author: Jae Hyun Kim Department of Pediatrics, Inje University Ilsan Paik Hospital, 170 Juhwa-ro, Ilsanseo-gu, Goyang 411-706, Korea, E-mail: pedendo@paik.ac.kr

Received 27 April 2015 Accepted 6 May 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Type 1 diabetes mellitus (T1DM) is characterized by an immune-mediated beta-cell destruction that causes lifelong insulin dependency. Diagnosis of diabetes is based on fasting glucose, 2-h plasma glucose value after a 75-g oral glucose tolerance test, or hemoglobin A1c (HbA1c) levels. Differentiation between type 1 and 2 diabetes is important for both education and treatment. Diabetes-associated autoantibodies, c-peptide and clinical characteristics should be considered to confirm the diagnosis of T1DM. A single HbA1c target of < 7.5% across all pediatric age groups is recommended. In nonpregnant adults, a reasonable HbA1c goal is < 7.0% to reduce the incidence of microvascular complications of T1DM. Glycemic targets should be individualized according to lifestyle, psychosocial and medical circumstances.

Keywords: Diagnosis, Glycemic target, Type 1 diabetes

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Table 1.

Criteria for the diagnosis of diabetes

A1C ≥ 6.5%. The test should be performed in a laboratory using a method that is NGSP certified and standardized to the DCCT assay.^a

FPG ≥ 126 mg/dL (7.0 mmol/L). Fasting is defined as no caloric intake for at least 8 h.^a

2-h PG ≥ 200 mg/dL (11.1 mmol/L) during an OGTT. The test should be performed as described by the WHO, using a glucose load containing the equivalent of 75 g anhydrous glucose dissolved in water.^a

In a patient with classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma glucose ≥ 200 mg/dL (11.1 mmol/L).

NGAP, The National Glycohemoglobin Standardization Program; DCCT, Diabetes Control and Complications Trial; FPG, fasting plasma glucose; PG, plasma glucose; OGTT, oral glucose tolerance test.

^a In the absence of unequivocal hyperglycemia, results should be confirmed by repeat testing. Adapted from Korean Diabetes Association: Treatment guideline for diabetes. 5th ed. Seoul: Gold's Planning and Development; 2013. p5–9 [7].

Table 2.

Clinical characteristics of type 1 and type 2 diabetes

Characteristic	Type 1 diabetes	Type 2 diabetes
Age of onset Clinical presentation Autoantibodies associated with diabetes	Mostly children, adolescents and young adults Most often acute, rapid with typical symptoms (polyuria, polydipsia, weight loss, fatigue) Approximately 85∼90% at onset	Mostly middle and old age Usually gradual with no frequently complaints < 20%
Ketosis Obesity Acanthosis nigricans Parent with diabetes	Common Population frequency No 2∼4%	Uncommon Increased frequency Yes Approximately 80%

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