From the Guidelines
For a patient newly diagnosed with diabetes, I would recommend ordering a comprehensive medical evaluation to confirm the diagnosis, classify diabetes, and evaluate for potential comorbid conditions, as outlined in the standards of medical care in diabetes-2019 1. This evaluation should include a complete medical history, physical examination, and laboratory tests such as HbA1c, comprehensive metabolic panel, lipid profile, and urine albumin-to-creatinine ratio.
- The initial visit should also focus on beginning patient engagement in the formulation of a care management plan and developing a plan for continuing care, including assessing the 10-year risk of a first atherosclerotic cardiovascular disease event using the race- and sex-specific Pooled Cohort Equations 1.
- Additionally, baseline laboratory tests should be ordered to assess attainment of A1C and metabolic targets, and to evaluate for diabetes complications and potential comorbid conditions.
- A follow-up visit should include most components of the initial comprehensive medical evaluation, including interval medical history, assessment of medication-taking behavior and intolerance/side effects, physical examination, laboratory evaluation, and assessment of risk for complications, diabetes self-management behaviors, nutrition, psychosocial health, and the need for referrals, immunizations, or other routine health maintenance screening 1.
- Ongoing management should be guided by the assessment of diabetes complications and shared decision making to set therapeutic goals, with a focus on reducing morbidity, mortality, and improving quality of life 1.
From the Research
Diagnostic Tests for Diabetes
When a patient is newly diagnosed with diabetes, several tests can be ordered to confirm the diagnosis and monitor the patient's condition. These tests include:
- Fasting plasma glucose (FPG) test: This test measures the level of glucose in the blood after an overnight fast 2, 3, 4.
- Hemoglobin A1c (HbA1c) test: This test measures the average level of glucose in the blood over the past 2-3 months 2, 5, 3, 6, 4.
- 2-hour postglucose-load plasma glucose test: This test measures the level of glucose in the blood after consuming a sugary drink 2, 4.
- Oral glucose tolerance test: This test measures the level of glucose in the blood after consuming a sugary drink 2.
Additional Tests
In addition to these diagnostic tests, other tests may be ordered to monitor the patient's condition and adjust treatment as needed. These tests include:
- Microalbuminuria test: This test measures the level of albumin in the urine, which can indicate kidney damage 6.
- Urine albumin-to-creatinine ratio test: This test measures the level of albumin in the urine compared to the level of creatinine, which can indicate kidney damage 3.
- Lipid profile test: This test measures the level of cholesterol and triglycerides in the blood, which can indicate an increased risk of heart disease 3.
- Blood pressure test: This test measures the level of blood pressure, which can indicate an increased risk of heart disease 3.
Combination of Tests
Using a combination of these tests can provide a more accurate diagnosis and monitoring of diabetes. For example, using both HbA1c and FPG tests can identify more people at risk of diabetes than using either test alone 3. Additionally, using HbA1c and plasma glucose measurements can reduce the risk of systematic bias inherent in HbA1c testing alone 2.