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Rodacki M, Zajdenverg L, da Silva Júnior WS, Giacaglia L, Negrato CA, Cobas RA, de Almeida-Pititto B, Bertoluci MC. Brazilian guideline for screening and diagnosis of type 2 diabetes: a position statement from the Brazilian Diabetes Society. Diabetol Metab Syndr 2025; 17:78. [PMID: 40038723 DOI: 10.1186/s13098-024-01572-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2024] [Accepted: 12/28/2024] [Indexed: 03/06/2025] Open
Abstract
BACKGROUND Patients with type 2 diabetes (T2D) often experience prolonged periods of asymptomatic hyperglycemia, which significantly increases the risk of developing chronic complications related to diabetes. Screening programs for individuals at high risk for T2D provide valuable opportunities not only for early diagnosis but also for detecting intermediate hyperglycemic states, commonly referred to as prediabetes. Interventions aimed at preventing diabetes in this group can successfully delay or even avoid the onset of the disease and its associated burdens. This review is an update of the Brazilian Diabetes Society (Sociedade Brasileira de Diabetes [SBD]) evidence-based guideline for diagnosing diabetes and screening T2D. METHODS The methodology was previously published and defined by the internal institutional steering committee. The working group drafted the manuscript by selecting vital clinical questions for a narrative review, utilizing MEDLINE via PubMed to identify relevant studies. The review assessed the best available evidence, including randomized clinical trials (RCTs), meta-analyses, and high-quality observational studies related to the diagnosis of diabetes. RESULTS AND CONCLUSIONS Fifteen specific recommendations were formulated. Screening is recommended for adults aged 35 and older or younger individuals with obesity and additional risk factors. For children and adolescents, screening is recommended starting at age ten or the onset of puberty if they are overweight or obese and have additional risk factors. Fasting plasma glucose (FPG) and HbA1c are recommended as initial screening tests. The oral glucose tolerance test (OGTT) is recommended for high-risk individuals with normal HbA1c and FPG or those with prediabetes. The 1-h OGTT is preferred over the 2-h OGTT, as it is both more practical and a superior test. A structured approach to reevaluation intervals is provided.
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Affiliation(s)
- Melanie Rodacki
- Departamento de Clínica Médica / Nutrologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Lenita Zajdenverg
- Departamento de Clínica Médica / Nutrologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Luciano Giacaglia
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Roberta Arnoldi Cobas
- Departamento de Medicina Interna, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Bianca de Almeida-Pititto
- Departamento de Medicina Preventiva, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Marcello Casaccia Bertoluci
- Serviço de Endocrinologia do Hospital de Clínicas de Porto Alegre. Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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de Bock M, Agwu JC, Deabreu M, Dovc K, Maahs DM, Marcovecchio ML, Mahmud FH, Nóvoa-Medina Y, Priyambada L, Smart CE, DiMeglio LA. International Society for Pediatric and Adolescent Diabetes Clinical Practice Consensus Guidelines 2024: Glycemic Targets. Horm Res Paediatr 2024; 97:546-554. [PMID: 39701064 PMCID: PMC11854972 DOI: 10.1159/000543266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2024] [Accepted: 12/14/2024] [Indexed: 12/21/2024] Open
Abstract
The International Society for Pediatric and Adolescent Diabetes (ISPAD) guidelines represent a rich repository that serves as the only comprehensive set of clinical recommendations for children, adolescents, and young adults living with diabetes worldwide. This chapter builds on the 2022 ISPAD guidelines, and updates recommendations on the glycemic targets for children and adolescents living with diabetes. A new target for hemoglobin A1c (HbA1c) of ≤6.5% (48 mmol/mol) is recommended for those who have access to advanced diabetes technologies like continuous glucose monitoring and automated insulin delivery. This target should be encouraged for all children and adolescents living with diabetes when safely achievable. In other settings, the HbA1c target is ≤7.0% (53 mmol/mol). The International Society for Pediatric and Adolescent Diabetes (ISPAD) guidelines represent a rich repository that serves as the only comprehensive set of clinical recommendations for children, adolescents, and young adults living with diabetes worldwide. This chapter builds on the 2022 ISPAD guidelines, and updates recommendations on the glycemic targets for children and adolescents living with diabetes. A new target for hemoglobin A1c (HbA1c) of ≤6.5% (48 mmol/mol) is recommended for those who have access to advanced diabetes technologies like continuous glucose monitoring and automated insulin delivery. This target should be encouraged for all children and adolescents living with diabetes when safely achievable. In other settings, the HbA1c target is ≤7.0% (53 mmol/mol).
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Affiliation(s)
- Martin de Bock
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
- Department of Paediatrics, Te Whatu Ora, Waitaha, New Zealand
| | | | - Matt Deabreu
- Parent and Advocate of Child with Type One Diabetes, Toronto, Ontario, Canada
| | - Klemen Dovc
- University Medical Centre Ljubljana, University Children's Hospital, Department of Endocrinology, Diabetes and Metabolic Diseases and University of Ljubljana Faculty of Medicine, Ljubljana, Slovenia
| | - David M Maahs
- Division of Endocrinology, Department of Pediatrics, Stanford University, Stanford, California, USA
| | - M Loredana Marcovecchio
- Department of Paediatrics, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Farid H Mahmud
- Division of Endocrinology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Yeray Nóvoa-Medina
- University Institute of Biomedical and Healthcare Research (IUIBS), University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain,
| | - Leena Priyambada
- Department of Pediatric Endocrinology, Rainbow Children's Hospital, Hyderabad, India
| | - Carmel E Smart
- Paediatric Endocrinology and Diabetes, John Hunter Children's Hospital, Newcastle, New South Wales, Australia
- School of Health Sciences, University of Newcastle, Newcastle, New South Wales, Australia
| | - Linda A DiMeglio
- Division of Pediatric Endocrinology and Diabetology, Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Qaraqe M, Elzein A, Belhaouari S, Ilam MS, Petrovski G. A novel few shot learning derived architecture for long-term HbA1c prediction. Sci Rep 2024; 14:482. [PMID: 38177624 PMCID: PMC10766611 DOI: 10.1038/s41598-023-50348-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 12/19/2023] [Indexed: 01/06/2024] Open
Abstract
Regular monitoring of glycated hemoglobin (HbA1c) levels is important for the proper management of diabetes. Studies demonstrated that lower levels of HbA1c play an essential role in reducing or delaying microvascular difficulties that arise from diabetes. In addition, there is an association between elevated HbA1c levels and the development of diabetes-related comorbidities. The advanced prediction of HbA1c enables patients and physicians to make changes to treatment plans and lifestyle to avoid elevated HbA1c levels, which can consequently lead to irreversible health complications. Despite the impact of such prediction capabilities, no work in the literature or industry has investigated the futuristic prediction of HbA1c using current blood glucose (BG) measurements. For the first time in the literature, this work proposes a novel FSL-derived algorithm for the long-term prediction of clinical HbA1c measures. More importantly, the study specifically targeted the pediatric Type-1 diabetic population, as an early prediction of elevated HbA1c levels could help avert severe life-threatening complications in these young children. Short-term CGM time-series data are processed using both novel image transformation approaches, as well as using conventional signal processing methods. The derived images are then fed into a convolutional neural network (CNN) adapted from a few-shot learning (FSL) model for feature extraction, and all the derived features are fused together. A novel normalized FSL-distance (FSLD) metric is proposed for accurately separating the features of different HbA1c levels. Finally, a K-nearest neighbor (KNN) model with majority voting is implemented for the final classification task. The proposed FSL-derived algorithm provides a prediction accuracy of 93.2%.
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Affiliation(s)
- Marwa Qaraqe
- College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar.
| | - Almiqdad Elzein
- College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
| | - Samir Belhaouari
- College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
| | - Md Shafiq Ilam
- College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
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