Raised blood glucose concentrationBMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a1073 (Published 25 September 2008) Cite this as: BMJ 2008;337:a1073
- Tim A Holt, clinical lecturer1,
- Claire J Holt, practice nurse2
- 1Health Sciences Research Institute, University of Warwick, Coventry CV4 7AL
- 2Kenyon Medical Centres, Willenhall, Coventry CV3 3AD
- Correspondence to: T Holt
- Accepted 3 May 2007
A 56 year old woman recently requested a cholesterol measurement and has come to discuss the results, which include a plasma glucose concentration of 8.3 mmol/l.
What issues you should cover
Can diabetes be diagnosed in this patient? Which further tests and what follow-up are needed?
Was it a fasting or a random sample? If fasting, can the patient confirm she had fasted for at least eight hours?
Does she have symptoms of diabetes? Some patients asking for a screening test may be concerned about symptoms, perhaps non-specific ones, including those of diabetes (thirst, polyuria, unexplained weight loss).
Does she have risk factors for diabetes? Discussion might include family history, ethnicity, and history of gestational diabetes or impaired glucose tolerance. Comorbid conditions that raise the risk of diabetes include dyslipidaemia, hypertension, central obesity, and cardiovascular disease.
Never pass off a concentration of ≥6.1 mmol/l in a random glucose test as “normal,” particularly in patients aged >40 years. Further testing is needed to clarify their diabetes status.
Unless a patient has symptoms that are clearly attributable to diabetes, confirm …