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at least every 6 months year in patients who are meeting treatment goals and who have stable glycemic control.

For patients whose therapy has changed or who are not meeting glycemic goals, the guidelines recommend Hb A Fructosamine levels also test for glucose levels.

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Measurements of IA2 autoantibodies within 6 months of diagnosis can help differentiate between type 1 and type 2 DM. Anti-GAD65 antibodies can be present at diagnosis of type 1 DM and are persistently positive over time.

(See also Type 2 Diabetes Mellitus.) Testing for islet autoantibodies can substitute for expensive genetic testing in those patients suspected of having maturity-onset diabetes of the young (MODY).

On occasion, a patient who is ultimately found to have type 1 DM presents with subtle symptoms because of residual insulin secretion.

Islet-cell (IA2), anti-GAD65, and anti-insulin autoantibodies can be present in early type 1 but not type 2 DM.

A study by Suzuki et al found that glycated albumin, which is not affected by Hb F levels, more strongly correlated with 1-month average postprandial blood glucose and was therefore a better marker of diabetes in neonates.

This finding is important to neonatologist and those caring for newborns.

The plasma acetone level—specifically, the beta-hydroxybutyrate level—is a more reliable indicator of DKA, along with measurement of plasma bicarbonate or arterial p H as clinically required.

(See the Medscape Reference Laboratory Medicine article Ketones.) However, in patients at high risk (eg, those who have first-degree relatives with type 1 DM), it may be appropriate to perform annual screening for anti-islet antibodies before the age 10 years, along with 1 additional screening during adolescence.

Howard A Bessen, MD Professor of Medicine, Department of Emergency Medicine, University of California, Los Angeles, David Geffen School of Medicine; Program Director, Harbor-UCLA Medical Center Howard A Bessen, MD is a member of the following medical societies: American College of Emergency Physicians Disclosure: Nothing to disclose.


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