Diabetes Diagnosis: Is One Test Enough?

Q: Diabetes Diagnosis: Is One Test Enough?

Dear Mr. Zhang： 1. According to the diagnostic criteria for diabetes set by the American Diabetes Association： a. Fasting plasma glucose level ≥ 126 mg/dL after fasting for more than 8 hours, b. Plasma glucose level ≥ 200 mg/dL during a 2-hour oral glucose tole

Diabetes Diagnosis Issues

Hello, doctor.
I would like to ask a question.
Recently, I was diagnosed with high blood sugar during a health check-up.
On November 9th, I went to the hospital for a blood test and found that my fasting blood glucose level was 142 mg/dL, and my hemoglobin A1c was 9.9%.
However, the doctor who examined me made a direct diagnosis of diabetes based on this single test.
To provide some context, my wife underwent surgery for colon cancer in early August, and I have been the sole caregiver for her day and night.
During this time, many friends and family members brought us large amounts of fruit (such as apples and pears).
Due to my caregiving responsibilities, my meals have been irregular and unhealthy, and my sleep has been inconsistent, often waking up at night to provide care, while also consuming a lot of fruit.

Considering that the hemoglobin A1c test reflects blood sugar levels over the past three months, and that this period coincides with my wife's hospitalization, could this situation have caused my hemoglobin A1c to spike suddenly? Additionally, is it standard practice to require multiple tests before definitively diagnosing diabetes? I am concerned because my doctor made the diagnosis based on just one blood test, and I would like to know if there might be an issue with this approach.
Thank you.

Mr. Zhang, 40~49 year old female. Ask Date: 2023/12/17

Dr. Xiao Yongxun reply Family Medicine

Dear Mr.
Zhang:
1.
According to the diagnostic criteria for diabetes set by the American Diabetes Association: a.
Fasting plasma glucose level ≥ 126 mg/dL after fasting for more than 8 hours, b.
Plasma glucose level ≥ 200 mg/dL during a 2-hour oral glucose tolerance test, c.
HbA1c ≥ 6.5% (this must be confirmed by a method that is certified by the National Glycohemoglobin Standardization Program (NGSP) and meets the standards of the Diabetes Control and Complications Trial (DCCT)), and the above criteria a, b, and c must be confirmed on two separate occasions.
d.
If there are clinical symptoms of diabetes (such as polyuria, polydipsia, polyphagia, and unexplained weight loss), a plasma glucose level ≥ 200 mg/dL on any one occasion is sufficient.
2.
Therefore, your physician should have made the diagnosis of diabetes based on the aforementioned criteria.
3.
The prevention or management of diabetes primarily involves dietary control and regular physical activity; medication should only be considered when necessary.
Dietary control includes eating until 80% full, avoiding fast eating or overeating, and steering clear of high-sugar, high-fat, and high-calorie foods or beverages, as well as instant coffee mixes, cakes, and fried foods.
Dinner should not be too heavy, and moderate activity should be undertaken after meals before going to bed.
Regular exercise is equally important, aiming for at least three sessions per week, each lasting about an hour; otherwise, at a minimum, a post-meal walk should be taken to avoid sitting down to work immediately.
Additionally, ensuring adequate sleep and reducing life stress can also aid in blood sugar control.
4.
The development of diabetes is gradual; therefore, by maintaining good dietary habits, exercising, and adjusting your lifestyle, it is possible to gradually improve your condition, potentially even without the need for medication.
5.
In your case, in addition to dietary and exercise control, it may be necessary to consider medication intervention initially to quickly reduce high blood sugar levels and mitigate the effects of glycation.
It is advisable to discuss this with your primary care physician.

Reply Date: 2023/12/17

More Info

When it comes to diagnosing diabetes, the question of whether one test is sufficient is a common concern among patients. According to the American Diabetes Association (ADA), the diagnosis of diabetes typically requires confirmation through multiple tests unless there are clear symptoms of hyperglycemia (high blood sugar). The standard diagnostic criteria include:
1. Fasting Plasma Glucose (FPG): A fasting blood sugar level of 126 mg/dL (7.0 mmol/L) or higher.

2. Oral Glucose Tolerance Test (OGTT): A 2-hour plasma glucose level of 200 mg/dL (11.1 mmol/L) or higher during an OGTT.

3. Hemoglobin A1c (HbA1c): An HbA1c level of 6.5% (48 mmol/mol) or higher.

4. Random Plasma Glucose: A random plasma glucose level of 200 mg/dL (11.1 mmol/L) or higher in a patient with classic symptoms of hyperglycemia or hyperglycemic crisis.

In your case, your fasting blood glucose level of 142 mg/dL and HbA1c of 9.9% are indeed indicative of diabetes. However, the ADA recommends that the diagnosis should ideally be confirmed with a second test unless there are clear symptoms of diabetes. This means that if your doctor diagnosed you based solely on one test, it may not align with the standard guidelines, which typically suggest a follow-up test for confirmation.

It is also important to consider the context of your recent lifestyle changes. The stress of caring for a loved one, irregular eating patterns, and increased consumption of fruits (which, while healthy, can also contribute to higher sugar intake) could have influenced your blood sugar levels. The HbA1c test reflects your average blood sugar levels over the past two to three months, so it is possible that the stress and dietary changes during your wife's hospitalization contributed to the elevated levels observed in your test.

If you are concerned about the accuracy of your diagnosis or the implications of your test results, it is advisable to discuss this with your healthcare provider. They may recommend additional testing or monitoring to better understand your blood sugar levels and overall health. Lifestyle modifications, including dietary changes, regular physical activity, and stress management, are crucial in managing diabetes.
In summary, while your test results suggest diabetes, the standard practice is to confirm the diagnosis with a second test unless there are clear symptoms. Given your recent circumstances, it would be beneficial to have a comprehensive discussion with your healthcare provider about your diagnosis, potential lifestyle adjustments, and any necessary follow-up testing. This will help ensure that you receive the most accurate diagnosis and appropriate care moving forward.

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