Interactive case study: Making a diagnosis of type 2 diabetes

Diabetes & Primary Care’s series of interactive case studies is aimed at GPs, practice nurses and other professionals in primary and community care who would like to broaden their understanding of type 2 diabetes.

The three mini-case studies presented with this issue of the journal take you through what to consider in making an accurate diagnosis of type 2 diabetes.

The format uses typical clinical scenarios as tools for learning. Information is provided in short sections, with most ending in a question to answer before moving on to the next section.

Working through the case studies will improve your knowledge and problem-solving skills in type 2 diabetes by encouraging you to make evidence-based decisions in the context of individual cases.

Crucially, you are invited to respond to the questions by typing in your answers. In this way, you are actively involved in the learning process, which is a much more effective way to learn.

By actively engaging with these case histories, I hope you will feel more confident and empowered to manage such presentations effectively in the future.

Colin is a 51-year-old construction worker. A recent blood test shows an HbA_1c of 67 mmol/mol.
Is this result enough to make a diagnosis of diabetes?

Rao, a 42-year-old accountant of Asian origin, is currently asymptomatic but has a strong family history of type 2 diabetes. Tests have revealed a fasting plasma glucose level of 6.7 mmol/L and an HbA_1c of 52 mmol/mol.
How would you interpret these results?

43-year-old Rachael has complained of fatigue. She has a BMI of 28.4 kg/m² and her mother has type 2 diabetes. Rachael’s HbA_1c is 46 mmol/mol.
How would you interpret her HbA_1c measurement?

By working through these interactive cases, you will consider the following issues and more:

• The criteria for the correct diagnosis of diabetes and non-diabetic hyperglycaemia.
• Which tests to use in different circumstances to determine a diagnosis.
• How to avoid making errors in classification of the type of diabetes being diagnosed.
• The appropriate steps to take following diagnosis.