Diabetes Diagnosis: Is There Room for Reassessment?

Is there still room for maneuver regarding the diagnosis of diabetes?

The company's health check showed a fasting blood glucose level of 131 mg/dL (with a hemoglobin A1c of 6.7% from late September).
Last week, I had a separate lipid panel test with a triglyceride level of 1100 mg/dL.
My height is 171 cm, and my weight is 92 kg.
I usually exercise regularly, more than three times a week, and I haven't specifically controlled my diet.
I found online that a second test is needed for a definitive diagnosis of diabetes.
Doctor, do I currently have diabetes, or do I need to wait for the follow-up appointment in three months and the repeat test to confirm?

Mr. Huang, 30~39 year old female. Ask Date: 2023/10/09

Dr. Li Jian reply Internal Medicine

Since the blood glucose levels were tested separately on two occasions, they meet the criteria for diabetes.
It is advisable to control it as soon as possible.

Reply Date: 2023/10/09

More Info

When it comes to diagnosing diabetes, the process is not always straightforward and often requires multiple assessments to ensure accuracy. According to the American Diabetes Association (ADA), the diagnosis of diabetes can be made based on several criteria, including fasting plasma glucose levels, oral glucose tolerance tests, and hemoglobin A1c (HbA1c) levels. Specifically, a fasting plasma glucose level of 126 mg/dL or higher, an HbA1c of 6.5% or higher, or a 2-hour plasma glucose level of 200 mg/dL or higher during an oral glucose tolerance test can indicate diabetes.
In your case, you mentioned that your fasting blood sugar was 131 mg/dL and your HbA1c was 6.7%. These values are indeed concerning and suggest that you may have diabetes. However, the ADA guidelines recommend that a diagnosis of diabetes should ideally be confirmed by a second test on a different day unless there are clear symptoms of hyperglycemia (such as excessive thirst, frequent urination, or unexplained weight loss). This means that while your current results are indicative of diabetes, a follow-up test is advisable to confirm the diagnosis.

It's also important to consider the context of your lifestyle and health. You mentioned that you exercise regularly and have not specifically controlled your diet. While regular physical activity is beneficial for managing blood sugar levels, dietary habits also play a crucial role in diabetes management. Consuming a balanced diet that is low in refined sugars and high in fiber can help regulate blood sugar levels.
Given your current situation, it would be prudent to schedule a follow-up appointment in three months to reassess your blood sugar levels and HbA1c. During this time, you might consider making some dietary adjustments, such as reducing your intake of high-sugar foods and beverages, and focusing on whole foods like vegetables, lean proteins, and whole grains. Additionally, maintaining your exercise routine will be beneficial.

In summary, while your current test results suggest that you may have diabetes, a second test is recommended for confirmation. It is essential to monitor your blood sugar levels regularly and make lifestyle adjustments to manage your health effectively. If you have any further concerns or symptoms, it would be wise to consult with your healthcare provider for personalized advice and management strategies.

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