Diabetes has become a major health threat to the whole world; indeed, the greatest increase will be contributed by India, which has already been declared by the World Health Organization (WHO) as the country with the largest number of diabetics in the world. Diabetes is frequently not diagnosed until complications appear, and approximately one third of all people with diabetes may be undiagnosed, though diagnosed many people are not aware of their condition.

Late detection of diabetes often means that at the time of diagnosis complications have already damaging the eyes, kidneys and nerves. These complications are costly in the physical, financial and psychosocial sense. Early detection and treatment of diabetes may not only improve glycemic control, but also improves blood pressure and lipids. Who should be screened? In general all adults should be screened at regular intervals

• Family history of diabetes (i.e., parents or siblings with diabetes)
• Overweight (Body Mass Index >25 kg/m2)
• Age >45 years
• Previously identified impaired fasting glucose (IFG) or impaired glucose tolerance (IGT)
• Hypertension (>140/90 mmHg)
• Hyperlipidemia (HDL - <35 mg/dL or triglyceride level >250 mg/dL or both)
• History of gestational diabetes or delivery of a baby over 9 lb (4.1 kg) (ADA -Diabetes Care 2004)

What are the Screening test for Diabetes

Fasting Plasma Glucose: The fasting plasma glucose (FPG) test is the standard test for diabetes. It is a simple blood test taken after eight hours of fasting. The FPG test is not always reliable, so a repeat test is recommended if the initial test suggests the presence of diabetes.

Oral Glucose Tolerance Test: The glucose tolerance test may be more accurate than the FPG in certain groups (e.g., women with a history of gestational diabetes). The test uses the following procedures: I) after an overnight fast Fasting Plasma Glucose test is performed. ii) After this test a person receives 75 g of glucose (100 g for pregnant women) blood samples are taken every half an hour {(fasting-30mts-60mts-90mts-120mts-(five times)} to measure the blood glucose. It not only helps in detecting diabetes but also help to detect the pre-diabetic status, Impaired Fasting Glucose (IFG) & Impaired Glucose Tolerance (IGT))

Is it important to detect pre-diabetic stage? Yes! Because it is “preventable” Criteria for the diagnosis of diabetes mellitus
Normal DIABETES
Symptoms of diabetes + Random plasma glucose <140 mg/dl ≥ 200 mg/dl
Fasting plasma glucose (FPG) NFG IFG ≥ 126 mg/dl

<100 mg/dl

100 – 125 mg/dl

Oral Glucose Tolerance Test (OGTT)
(WHO, 2004) NGT IGT ≥200 mg/dl
<140 mg/dl 140–199 mg/dl

What is the test for diabetic who is on treatment to detect the control of blood sugar? Test for Glycosylated Haemoglobin: Tests for blood levels of glycosylated hemoglobin, also known as hemoglobin A1C (HbA1c) are useful for determining the severity of diabetes. A glycosylated hemoglobin level of 1% above normal range (5%) identifies diabetes in 98% of patients. The test is not affected by food intake so it can be taken at any time. It shows average blood sugar control of 2-3 months. HbA1c - < 7, should be screened six months once.

What are the routine screening tests for Diabetes Complications? : All patients with a diagnosis of diabetes should receive routine screening for diabetes complications.

Screening for Heart diseases

• Blood pressure check up, regular at every visit for Hypertension (High blood pressure) - should be <130-80 mm/hg,
• Lipids test (Bad cholesterol(LDL),Low good cholesterol(HDL)& ,high triglyceride) , Check-up : six months once-Should be LDL <100,TGL <150 &HDL >40
• An electrocardiogram (ECG), that provides information about the status of heart
• Chest X ray, information about the lungs and shape of the heart and vascular system (aorta and blood vessels)
• Carotid Intima-media Thickness (IMT), marker of early atherosclerosis

Diabetic Nephropathy (Kidney Damage): Person with diabetes are several times more prone to kidney disease than the general population. The earliest manifestation of kidney damage is microalbuminuria, (tiny amounts of protein called albumin are found in the urine). Symptoms include Protein in the urine, High blood pressure, burning during urination, frequent urination, puffiness and swelling around the eyes, hand & feet, excessive itching, nausea, vomiting & weakness.

About 20% of type 2 patients show evidence of microalbuminuria upon diagnosis of diabetes, however, only a small percentage of type-2 diabetics eventually develops kidney disease. Microalbuminuria typically shows up in type 2 diabetics who have high blood pressure. Normal: <30;

Microalbuminuria: 30-299 (earliest stage) Macroalbuminuria: ≥300 (progression to End Stage Renal Disease (ESRD)) screening test: Microalbuminuria, Protein (urine) Creatinine, urea (blood) Diabetic Neuropathy: (Nerve damage) All patients should be examined for loss of sensation (neuropathy). The symptoms of neuropathy depend on which nerves and what part of the body is affected. It include: numbness or insensitivity to pain or temperature; tingling, burning, or pricking; sharp pains or cramps; sensitivity to touch; loss of balance and coordination. Symptoms can get worse at night.

Peripheral neuropathy affects the feet and hands and autonomic neuropathy affects the internal organs. Neuropathy is diagnosed by the use of very simple devices like Biothesiometer & Monofilament test, performed by trained technicians. These tests are very simple and in-expensive. ABR index < 0.8 indicates normal.

Diabetic Foot examination: Foot problems are important cause of morbidity in diabetic people and they should be examined for reduced blood flow towards limb (legs & feet). Foot problems such as ulceration, infections, necrosis, gangrene and amputation are quite common. These can be diagnosed through a simple device like monofilament (10gm) - to check the foot sensation and Emed pressure measurement system – to check the amount of pressure at various parts of the feet and to predict the changes of getting callus in the feet & Jerk is observed in the ankle & knee using Knee hammer. These test are performed by trained nurses and qualified podiatrist

Diabetic Vasculopathy: When the arteries & veins are affected due to diabetes it is known diabetic Vasculopathy. It shows reduced blood flow towards the limbs. It is examined by Doppler test, which record the blood pressure and arterial pulsations in the upper & lower limb and Ankle Brachial Index ABI is measured. This test is Simple, quiet and non-invasive assessment. The vascular system is performed by doctors and trained technicians. ABI index <0.9 indicates normal.

Diabetes-Retinopathy (related eye): Of many complications of diabetes, blindness is perhaps the most feared. Diabetic subjects are twice to develop eye problems and 60% of those having diabetes for >15yrs will develop diabetic retinopathy in their lifetime. Who are more prone to Diabetic retinopathy? : Uncontrolled blood sugar, longstanding diabetes, Hypertension with diabetes & Genetic predisposition.

What are the stages of retinopathy? : Mild non proliferative diabetic retinopathy (NPDR), Moderate-non proliferative diabetic retinopathy, severe retinopathy, Maculopathy and Proliferative diabetic retinopathy. Treatment: Retinopathy can be treated through laser photocoagulation. Screening test: Patients with diabetes should have an initial dilated and comprehensive eye examination by an ophthalmologist or optometrist right from the day of diagnosis of diabetes and every year thereafter. Early detection, timely treatment, appropriate screening and care reduce the risk of vision loss & 90% of diabetes related blindness