The management of type 2 diabetes mellitus FOCUS on quality

Diabetes mellitus (DM) is a group of metabolic disorders associated with abnormalities in carbohydrate, lipid, and protein metabolism [1-3]. The common feature of DM-hyperglycemia-is caused by defects in insulin secretion, insulin action (resistance), or both, with resulting long-term damage to various organs and diminished quality of life. The upper limit of normal fasting plasma glucose is 109 mg/dL. Although this number is somewhat arbitrary, values above this level are associated with a progressively greater risk of developing the many micro- and macrovascular complications associated with DM. The American Diabetes Association (ADA) has established three ways in which one can diagnose a patient as having DM (Box 1) [2,4]. Hemoglobin Alc (HbA1c) levels correlate with the average level of blood glucose over the previous I to 3 months [4-6]. Correlation is higher for glucose levels at lunch time than earlier in the day and is higher for glucose levels in the most recent 30 days than from the prior 31 to 120 days [7]. Although useful in monitoring the degree of glycemic control, the ADA currently does not recommend Its use for diagnostic purposes because there is a lack of its standardization among laboratories. Some investigators advocate its use in diagnosing DM, however, especially when performed in centers in which the test has been standardized [4].