Recently, the American Diabetes Association (ADA) released the 2023 edition of the 'Application of Laboratory Analysis in the Diagnosis and Treatment of Diabetes,' published in the Diabetes Care journal. This guideline serves as a crucial supplement to ADA's clinical guidelines, aiming to provide standardized guidance and explanations for the rational use of laboratory tests during diabetes screening, diagnosis, and monitoring.

The guideline emphasizes that individuals aged ≥35 years should undergo diabetes screening.

Image Source：https://doi.org/10.2337/dci23-0036

Recommendation for Diabetes Screening in Individuals ≥35 Years Old

I Regarding diabetes screening, the guidelines recommend:

For individuals at high risk of diabetes, it is advised to use Hemoglobin A1c (HbA1c), Fasting Plasma Glucose (FPG), or the 2-hour Oral Glucose Tolerance Test (OGTT-2h) for screening.If HbA1c is <5.7% (<39 mmol/mol), FPG is <5.6 mmol/L (<100 mg/dL), and/or OGTT-2h is <7.8 mmol/L (<140 mg/dL), diabetes can be ruled out. However, even in such cases, retesting should be conducted every 3 years.Additionally, venous plasma blood should be used for diabetes screening or diagnosis.

Due to the increasing incidence of Type 2 diabetes in children, the guidelines recommend regular diabetes screening for children with risk factors. High-risk factors include being overweight or obese (BMI >85%), a family history of diabetes, belonging to a high-risk racial/ethnic group, insulin resistance-related signals, and mothers diagnosed with diabetes or gestational diabetes (GDM) during pregnancy.It is recommended to start screening at the age of 10, and then every 3 years.This helps in early detection of diabetes in children, enabling necessary measures to be taken.

Women with a history of GDM should undergo diabetes screening within 4-12 weeks postpartum.Patients with a history of GDM should undergo regular diabetes screening for life, at least once every 3 years.

HbA1c should be checked no less than every 6 months

HbA1c is a product formed by the non-enzymatic combination of glucose with hemoglobin. Its formation process is continuous, slow, and irreversible. Therefore, it is generally believed that the concentration of HbA1c can effectively reflect the average blood glucose level over the past 8 to 12 weeks.The "Chinese Guidelines for the Prevention and Treatment of Type 2 Diabetes (2020 Edition)" point out that HbA1c is the "gold standard" for reflecting the average level of long-term blood sugar control.

 I Regarding the setting of HbA1c target values, the guidelines recommend

•Diagnostic criteria for diabetes: HbA1c ≥ 6.5%

•Prediabetes diagnostic criteria: HbA1c 5.7%~6.4%

Frequency of checks: Most diabetes patients should undergo regular HbA1c checks, initially typically every 3 months, until individualized target levels are reached. Afterward, the frequency of checks can be reduced to no less than every 6 months to monitor blood sugar control.

Once diagnosed with type 2 diabetes, it is recommended to undergo a urine albumin test at least once a year

Under normal circumstances, albumin in the bloodstream is filtered through the glomeruli in the kidneys and then reabsorbed by the renal tubules to prevent its loss in the urine, thus maintaining the body's protein load balance. However, in certain diseases or kidney issues, this mechanism may be compromised, leading to the presence of albumin in the urine.Therefore, the appearance of albumin in urine serves as a sensitive indicator of early kidney damage in diabetes.

I Regarding kidney function screening, the guideline recommends:

Regardless of the treatment method, for individuals diagnosed with type 1 diabetes for 5 years and at the time of diagnosis for type 2 diabetes, proteinuria testing should be conducted annually.If the estimated glomerular filtration rate (eGFR) is <60 mL/min/1.73 m2 or the urine albumin/creatinine ratio (UACR) is >30 mg/g in the urine sample, UACR should be retested every 6 months to monitor disease progression.

References:

[1]David B. Sacks, Mark Arnold, George L. Bakris, David E. Bruns, Andrea R. Horvath, Åke Lernmark, Boyd E. Metzger, David M. Nathan, M. Sue Kirkman; Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus. Diabetes Care 2023;dci230036. https：//doi.org/10.2337/dci23-0036