There may be no complaints. The MoH RK 2022 protocol says this directly: when hyperglycaemia is detected incidentally, complaints may be absent. ADA 2026 builds screening of asymptomatic adults not on polyuria but on a risk map.
Screening here means actively looking for prediabetes or T2DM in a person without the classic symptoms of hyperglycaemia. It is not a general "check-up" and not a "just in case" test for everyone in the emergency department.
ADA 2026 Recommendation 2.11: screening for prediabetes and T2DM risk in asymptomatic adults is done using risk factors or a validated risk calculator (level B). Recommendation 2.12a: testing should be considered in adults of any age with overweight or obesity who have at least one additional risk factor. The body mass index (BMI) threshold is ≥25 kg/m², and for people of Asian ancestry ≥23 kg/m² (Table 2.5). Recommendation 2.12b: for everyone else, screening starts at age 35 (level B). If the result is normal, repeat at least every 3 years, sooner if symptoms appear or risk changes, for example with weight gain (2.12c, level C).
The list of factors in ADA 2026 Table 2.5 starts with a first-degree relative with diabetes and includes high-risk racial/ethnic groups, a history of cardiovascular disease, arterial hypertension, low high-density lipoprotein (HDL) cholesterol / high triglycerides, polycystic ovary syndrome, physical inactivity, and other conditions associated with insulin resistance (including acanthosis nigricans). Separate pathways are a history of gestational diabetes, HIV, high-risk medications, pancreatitis and periodontitis. The student reads the full table in the primary source; the course does not require memorising it "from the tenth item onwards". It requires something else: not waiting for thirst.
Why a BMI of 23 rather than 25 for people of Asian ancestry. This is not a "courtesy racial adjustment". ADA 2026 records that at the same BMI the proportion of visceral fat and the risk of diabetes are higher in people of Asian ancestry; the screening threshold is therefore shifted. This is a professional society recommendation, not the result of a single RCT of "BMI 23 vs 25". ADA does not explicitly transfer the 23 kg/m² threshold automatically to all Central Asian populations as "Asian": the source's wording is "individuals of Asian ancestry". For Kazakhstan, the 2022 local protocol relies on glucose and HbA1c in its diagnostic section rather than on a separate BMI table for screening; a national threshold of "start screening at BMI 23" was not found in the open text of protocol No. 158.
The MoH RK 2022 protocol describes a typical history differently from how ADA describes screening: "The disease usually manifests after the age of 40 and is preceded by components of the metabolic syndrome (obesity, arterial hypertension, etc.)". This is a clinical portrait of onset, useful for differential diagnosis from type 1 diabetes, but dangerous if read as "there is no T2DM before 40". ADA 2026 deliberately breaks this frame: both type 1 and type 2 occur at all ages; up to 40% of adults with new type 1 diabetes are initially mistaken for type 2.
The paediatric pathway, so as not to confuse it with the adult one. ADA 2026 Recommendation 2.15: risk-based screening after the onset of puberty or after age 10 (whichever comes first) in children and adolescents with overweight (BMI ≥85th percentile) or obesity (≥95th) plus at least one risk factor. The MoH RK 2022 protocol is written for adults and does not contain this threshold. A student used to adults who examines an adolescent does not extrapolate "from age 35".
A gestational history is a separate risk multiplier, not "already diabetes". A woman with past gestational diabetes does not automatically receive a diagnosis of T2DM. She falls into a group for which ADA recommends more frequent screening. Gestational diabetes itself is not covered in this course.
The take-home point of the lesson. A risk factor does not make the diagnosis. It changes the probability with which you will order glucose and HbA1c for a person who came "for another reason". Complaints are a late filter. Screening is an early one.