DIABETES MELLITUS TYPE 2 - Standard Treatment Workflow (STW)

Q: How should screening for diabetes be done in different populations?

Screen apparently normal adults with obesity/overweight plus risk factors, screen ill adults presenting suggestive complaints (e.g., osmotic symptoms, recurrent infections, non-healing ulcers), and in pregnancy screen in the 1st trimester with FPG, followed by confirmatory testing for normal 1st trimester results and structured follow-up for GDM.

Oct 12, 2026

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Diabetes Mellitus Type 2 standard treatment workflow outlines symptoms, diagnostic criteria, assessment of co-morbidities, and the stepwise approach to investigation and treatment. It covers prediabetes definitions, metabolic targets for HbA1c and capillary plasma glucose, monitoring frequency for glycemic control and complications, and referral pathways across endocrinology, ophthalmology, nephrology, and cardiology. It also specifies diabetes screening strategies in apparently healthy adults, ill patients, and pregnancy, plus relevant abbreviations and advisory guidance.

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Symptoms

Diagnosis

Prediabetes

Assessment and Examination

Investigations

Treatment

Metabolic Targets

Monitoring and Referrals

Screening for Diabetes Mellitus

Abbreviations

July/ 2022 Department of Health Research Ministry of Health and Family Welfare, Government of India Standard Treatment Workﬂow (STW) DIABETES MELLITUS TYPE 2 ICD-10-E11 SYMPTOMS May be asymptomatic Osmotic symptoms ie., polyuria, polydipsia and polyphagia Weight loss Non healing wounds Recurrent infections Blurring of vision Paraesthesia DIAGNOSIS | | OR | | OR | | OR

Diabetes symptoms + random plasma glucose ≥ 200 mg/dl | | --- | --- | --- | --- | --- | --- | | FPG ≥126
mg/dl
(after 8hr
fasting) | | | | HbA1C ≥
6.5% | | PREDIABETES: Impaired fasting glucose: FPG 100-125 mg/dL; Impaired glucose tolerance: 140-199 mg/dL; HbA1c 5.7-6.4% ASSESS CO-MORBIDITIES: Hypertension Dyslipidaemia CAD CKD BMI EXAMINATION: waist circumference BP Peripheral pulses Pin-prick sensation, monoﬁlament test ,vibration, DTR Skin, oral cavity, foot Fundus (dilated) examination INVESTIGATION • HbA1c • Creatinine • K+ • Fasting lipid proﬁle • Urine routine examination and spot albumin: creatinine ratio\# • LFT/ ALT, AST • ECG • Others like Echo, USG abdomen as indicated \#These may best be carried out after initial glycaemic control TREATMENT • Dietary modiﬁcation • Avoidance of tobacco and restriction/ avoidance of alcohol • Physical activity • Pharmacotherapy: › HbA1c < 8.5%: Monotherapy-Metformin › HbA1c 8.5-10%: Dual therapy-Metformin + SU’s/TZD/ DPPIVi/SGLT2i /AGI/GLP-1RA › HbA1c > 10%: Basal Insulin+ Metformin + another OAD / triple OAD combination METABOLIC TARGETS • HbA1c 250 mg/dL, HDL <40 mg/dl in male, <50 mg/dlin female • Physical inactivity • Polycystic ovary syndrome (PCOS) • Insulin resistance (acanthosis nigricans) • Adults > 30 years of age • Previous history of GDM IN AN ADULT WITH ILLNESS • In any adult/adolescent who presents with one of the following illness/complaints • Osmotic symptoms (polyuria, polydipsia, polyphagia, nocturia) • Unexplained weight loss • Unexplained depression or dementia • Acute coronary syndrome • Deep seated infections (liver abscess, lower lobe pneumonia, tuberculosis, pyelonephritis, abscesses, septic arthritis, osteomyelitis) • Recurrent infections (tinea, oral thrush, onychomycosis, cystitis-urinary tract infection, sinusitis, STI, cellulitis, carbuncle) • Non-healing ulcers (foot ulcers-infected/neuropathic) • Exogenous/iatrogenic Cushing’s syndrome IN PREGNANCY • H/O GDM/Pre-existing diabetes • All pregnant women to be screened in 1st trimester with FPG • FPG ≥ 126 and/or HbA1c ≥ 6.5% to be considered pre-existing diabetes • FPG between 92-125 to be considered as GDM • All those women with normal screening in 1st trimester to get a 75 g-oral glucose tolerance test done at 24-28 weeks • All GDM women to be tested 6 weeks post-partum and once every 3 years • PREDIABETES: should be tested yearly ABBREVIATIONS ALT: Alanin

FAQs

What are the diagnostic criteria for Diabetes Mellitus Type 2?

Diabetes is diagnosed using criteria such as random plasma glucose ≥ 200 mg/dl with symptoms, FPG ≥ 126 mg/dl after 8 hours fasting, or HbA1c ≥ 6.5%.

What metabolic targets should be followed for treatment?

The workflow targets HbA1c ≤ 7.0% (with exceptions for elderly and significant comorbidities), pre-prandial capillary glucose 80–130 mg/dl, post-prandial glucose < 180 mg/dl, and BP and LDL targets (with lower LDL for CAD).

How should screening for diabetes be done in different populations?

Screen apparently normal adults with obesity/overweight plus risk factors, screen ill adults presenting suggestive complaints (e.g., osmotic symptoms, recurrent infections, non-healing ulcers), and in pregnancy screen in the 1st trimester with FPG, followed by confirmatory testing for normal 1st trimester results and structured follow-up for GDM.

Oct 12, 2026

Upload by Connor