Professional Documents
Culture Documents
Introduction
Multiple
laboratory
tests
are
used
to
diagnose
and
manage
patients
with
diabetes
mellitus
Diabetes
mellitus
is
a
group
of
metabolic
disorders
of
carbohydrate
metabolism
in
which
glucose
is
underutilized
and
overproduced,
causing
hyperglycemia.
Classification
:
- Type
1
DM
- Type
2
DM
- Gestasional DM
- Other
specific
types
Diabetes
Prediabetes
Normal
HbA1c (%)
Glukosa
Darah Puasa
(mg/dL)
Glukosa Plasma
2
jam
setelah TTGO
(mg/dL)
> 6,5
> 126
> 200
5,7-6,4
100-125
140-199
< 5,7
< 100
<
140
Perkeni,
2015
Belum Pasti
DM
DM
<100
100-199
200
<90
90-199
200
<100
100-125
126
<90
90-99
100
Glucosemeter
Portable
meters
for
the
measurement
of
blood
glucose
concentrations
are
used
in
three
major
settings:
1)
in
acute- and
chronic-care
facilities,
including
intensive
care
units
(ICUs);
2)
in
physicians
offices;
3)
by
patients
at
home,
work,
and
school self-
monitoring
of
blood
glucose
(
SMBG).
SMBG is
recommended
for
all
insulin-treated
patients.
Intensive
glycemic
control
can
decrease
microvascular
complications
in
individuals
with
type
1
or
type
2
diabetes.
The
role
of
SMBG in
individuals
with
type
2
diabetes
has
generated
considerable
controversy.
o
o
o
Glucosemeter
Patients
should
be
instructed
in
the
correct
use
of
glucose
meters,
including
quality
control.
Important
variables
that
may
influence
the
results
of
bedside
glucose
monitoring
include
changes
in
hematocrit,
altitude,
environmental
temperature
or
humidity,
hypotension,
hypoxia
and
high
triglyceride
concentrations,
and
various
drugs.
Most
meters
are
inaccurate
at
very
high
or
very
low
glucose
concentrations.
Glucosemeter
Manufacturers
claim
reportable
concentration
ranges
as
large
as
33.3
mmol/L
(600
mg/dL),
e.g.,
033.3
mmol/L
(0600
mg/dL).
In
1987,
ADA
recommended
a
goal
of
total
error
(user
plus
analytical)
of
<10%
at
glucose
concentrations
of
1.722.2
mmol/L
(30400
mg/dL).
In
addition,
the
ADA
proposed
that
values
should
differ
by
15%
from
those
obtained
by
a
laboratory
reference
method.
A
revised
performance
goal,
published
in
1996
,
was
for
a
total
analytical
error
of
<5%.
ADA, 2015
Urinary
Glucose
RECOMMENDATION:
SEMIQUANTITATIVE URINE
GLUCOSE
TESTING
IS
NOT
RECOMMENDED FOR
ROUTINE
CARE
OF
PATIENTS
WITH
DIABETES
MELLITUS.
Urine
glucose
provides
no
information
about
blood
glucose
concentrations
below
the
renal
glucose
threshold
[10
mmol/L
(180
mg/dL)].
Urine
glucose
also
cannot
distinguish
euglycemia and
hypoglycemia.
The
strips
use
the
glucose
oxidase
reaction.
They
are
subject
to
numerous
interferences,
including
numerous
drugs
and
nonglucose
sugars.
Keton Testing
The
ketone
bodies
acetoacetate
(AcAc),
acetone,
and
-hydroxybutyric
acid
(HBA)
are
catabolic
products
of
free
fatty
acids.
Measurements
of
ketones
in
urine
and
blood
are
widely
used
in
the
management
of
patients
with
diabetes
as
adjuncts
for
both
diagnosis
and
ongoing
monitoring
of
DKA.
Reference
intervals
for
HBA differ
among
assay
methods,
but
concentrations
in
healthy
individuals
who
have
fasted
overnight
are
generally
<0.5
mmol/L.
Patients
with
well-documented
DKA [serum
CO2 <17
mmol/L,
arterial
pH
<7.3,
plasma
glucose
>14.9
mmol/L
(250
mg/dL)]
generally
have
HBA concentrations
>2
mmol/L.
HbA1c
Principally
on
the
basis
of
the
DCCT results,
the
ADA
has
recommended
that
a
primary
goal
of
therapy
be
an
HbA1c value
<7%
(53
mmol/mol).
For
selected
individual
patients,
more-stringent
targets
could
be
suggested,
such
patients
might
include
those
with
a
short
duration
of
diabetes,
a
long
life
expectancy,
and
no
significant
cardiovascular
disease
.
Conversely,
higher
HbA1c goals
should
be
chosen
for
patients
with
a
history
of
severe
hypoglycemia,
a
limited
life
expectancy,
advanced
microvascular or
macrovascular complications,
or
extensive
comorbid
conditions.
Glycated Albumin
Terima Kasih