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It outlines how to diagnose and screen diabetes mellitus in Singapore, specifying diagnostic thresholds for casual, fasting, and post-challenge plasma glucose, and guidance for confirmatory testing when results are discordant or near cut points. The booklet also addresses recognition of impaired glucose metabolism states, screening intervals by risk profile, and lifestyle and nutrition therapy principles for diabetes management.",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":51,"@type":70,"position":76},"https://docshare.wps.com/template/general/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/diabetes-mellitus-summary-booklet-moh-clinical-practice-guidelines-1-2014/565149/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/diabetes-mellitus-summary-booklet-moh-clinical-practice-guidelines-1-2014/565149.png","ImageObject",442,249,{"name":88,"@type":89},"nayy☆","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-24","2026-10-12",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",7,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"What evidence levels and grades of recommendation are used in the booklet?","Question",{"text":109,"@type":110},"The booklet defines Levels of evidence (e.g., 1+, 2++, 3, 4) and links them to Grades of recommendation (A, B, C, D, and GPP). These grades reflect the quality and applicability of underlying studies or best practice based on clinical experience.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"How is diabetes mellitus diagnosed in patients with hyperglycaemic crisis or typical symptoms?",{"text":114,"@type":110},"In hyperglycaemic crisis, diabetes mellitus can be diagnosed without further testing. In patients with typical symptoms, diagnosis is possible when any of the stated thresholds are present: casual plasma glucose ≥11.1 mmol/L, fasting plasma glucose ≥7.0 mmol/L, or 2-hour post-challenge plasma glucose ≥11.1 mmol/L.",{"name":116,"@type":107,"acceptedAnswer":117},"How often should screening be done in adults with normal glucose tolerance versus impaired states?",{"text":118,"@type":110},"For those with normal glucose tolerance, screening should be carried out every three years. For those with impaired fasting glycaemia (IFG) or impaired glucose tolerance (IGT), screening should be done annually.","https://schema.org",{"og:url":78,"og:type":121,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":123,"canonical":78},"index,follow",{"doc_id":125,"site_id":56},565149,1792119265,{"code":4,"msg":5,"data":128},{"doc_id":125,"user_id":129,"nickname":88,"user_avatar":130,"doc_module":9,"category_id":50,"category_name":51,"doc_title":59,"doc_description":61,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":136,"language":137,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":138,"faqs":139,"seo_title":140,"seo_description":61,"update_tm":141,"read_time":142},962090893153,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","Diabetes Mellitus  \n(Summary Booklet)  \nMOH Clinical Practice Guidelines 1/2014  \nAcademy of Medicine, Singapore  \nMar 2014  \nChapter of Endocrinologists College of Physicians, Singapore  \nSingapore Medical Association  \nLevels of evidence and grades of recommendation   \nLevels of evidence  \n\n| Level Type of Evidence |  |\n| --- | --- |\n| 1+ +\u003Cbr>1+\u003Cbr>1-\u003Cbr>2+ +\u003Cbr>2+\u003Cbr>2-\u003Cbr>3\u003Cbr>4 | High quality meta-analyses, systematic reviews of randomised controlled trials (RCTs), or RCTs with a very low risk of bias Well conducted meta-analyses, systematic reviews of RCTs, or RCTs with a low risk of bias\u003Cbr>Meta-analyses, systematic reviews of RCTs, or RCTs with a high risk of bias\u003Cbr>High quality systematic reviews of case control or cohort studies. High quality case control or cohort studies with a very low risk of confounding or bias and a high probability that the relationship is causal\u003Cbr>Well conducted case control or cohort studies with a low risk of confounding or bias and a moderate probability that the relationship is causal\u003Cbr>Case control or cohort studies with a high risk of confounding or\u003Cbr>bias and a significant risk that the relationship is not causal Non-analytic studies, e.g. case reports, case series Expert opinion |\n\nGrades of recommendation  \n\n| Grade Recommendation |  |\n| --- | --- |\n| A\u003Cbr>B\u003Cbr>C\u003Cbr>D\u003Cbr>GPP\u003Cbr>(good practice\u003Cbr>points) | At least one meta-analysis, systematic review of RCTs, or RCT rated as 1+ + and directly applicable to the target population; or A body of evidence consisting principally of studies rated as 1+ , directly applicable to the target population, and demonstrating overall consistency of results\u003Cbr>A body of evidence including studies rated as 2++ , directly applicable to the target population, and demonstrating overall consistency of results; or\u003Cbr>Extrapolated evidence from studies rated as 1+ + or 1+\u003Cbr>A body of evidence including studies rated as 2+ , directly applicable to the target population and demonstrating overall consistency of results; or\u003Cbr>Extrapolated evidence from studies rated as 2+ +\u003Cbr>Evidence level 3 or 4; or Extrapolated evidence from studies rated as 2+\u003Cbr>Recommended best practice based on the clinical experience of the guideline development group. |\n\nExecutive summary of recommendations  \nDetails of recommendations can be found in the main text at the pages indicated.  \nDiagnosis and screening of diabetes mellitus in Singapore  \nD In patients with hyperglycaemic crisis, diabetes mellitus can be diagnosed without further testing (pg 42) .  \nGrade D, Level 4  \nB In patients with typical symptoms, diabetes mellitus can be diagnosed if any one of the following is present.  \n1. Casual plasma glucose ≥11.1 mmol/l  \n2. Fasting plasma glucose ≥7.0 mmol/l  \n3. 2-hour post-challenge plasma glucose ≥11.1 mmol/l  \nOther individuals should have a repeat test on a subsequent day (pg 42) .  \nGrade B, Level 2++  \nD When two different tests are available for the same patient and the results for both tests are above the diagnostic thresholds, the diagnosis of diabetes is confirmed (pg 42) .  \nGrade D, Level 4  \nD When two different tests are available in an individual and the results are discordant, the test whose result is above the diagnostic cut point (usually the fasting plasma glucose or 2-hour post-challenge glucose) should be repeated (pg 42) .  \nGrade D, Level 4  \nD Fasting plasma glucose measured in an accredited laboratory is the preferred test for the diagnosis of diabetes mellitus (pg 43) .  \nGrade D, Level 4  \nB All subjects with fasting plasma glucose from 6.1 to 6.9 mmol/l should undergo a 75 g oral glucose tolerance test to determine if they have impaired glucose tolerance or diabetes mellitus (pg 43) .  \nGrade B, Level 2++  \n1  \nD If a second test fails to confirm the diagnosis, barring a laboratory error, such patients are likely to have test results near the margins of the threshold for a diagnosis. The healthcare professional might opt to follow the patie","cbCaicrh8R6wYxZI","https://ap.wps.com/l/cbCaicrh8R6wYxZI","pdf",1319144,38,"English","# Levels of evidence and grades of recommendation\n## Levels of evidence\n## Grades of recommendation\n# Executive summary of recommendations\n## Diagnosis and screening of diabetes mellitus in Singapore\n## Flowchart for the diagnosis of diabetes mellitus\n## Lifestyle modification","[{\"question\":\"What evidence levels and grades of recommendation are used in the booklet?\",\"answer\":\"The booklet defines Levels of evidence (e.g., 1+, 2++, 3, 4) and links them to Grades of recommendation (A, B, C, D, and GPP). These grades reflect the quality and applicability of underlying studies or best practice based on clinical experience.\"},{\"question\":\"How is diabetes mellitus diagnosed in patients with hyperglycaemic crisis or typical symptoms?\",\"answer\":\"In hyperglycaemic crisis, diabetes mellitus can be diagnosed without further testing. In patients with typical symptoms, diagnosis is possible when any of the stated thresholds are present: casual plasma glucose ≥11.1 mmol/L, fasting plasma glucose ≥7.0 mmol/L, or 2-hour post-challenge plasma glucose ≥11.1 mmol/L.\"},{\"question\":\"How often should screening be done in adults with normal glucose tolerance versus impaired states?\",\"answer\":\"For those with normal glucose tolerance, screening should be carried out every three years. For those with impaired fasting glycaemia (IFG) or impaired glucose tolerance (IGT), screening should be done annually.\"}]","Diabetes Mellitus - Summary Booklet - MOH Clinical Practice Guidelines 1-2014 | PDF",1791847216,13]