SCREENING, DIAGNOSIS AND RECOMMENDED TARGETS OF DIABETES

  • What is the screening criteria for assessing the risk for future diabetes?
  • What is the diagnostic criteria for pre-diabetes and diabetes?
  • What are the recommended blood glucose targets for adults with diabetes?
What is the screening criteria for assessing the risk for future diabetes?

According to the American Diabetes Association (ADA) to assess risk for future diabetes in asymptomatic people should be considered in adults of any age who are overweight or obese (BMI > 25 kg/m2 or > 23 kg/m2 in Asian Americans) and who have one or more additional risk factors:

  • physical inactivity
  • first-degree relative with diabetes
  • high-risk race/ethnicity (e.g., African American, Latino, Native American, Asian American, Pacific Islander)
  • women who delivered a baby weight >9 lbs or were diagnosed with GDM
  • hypertension (≥140/90 mmHg or on therapy for hypertension)
  • HDL cholesterol level <35 mg/dL (0.90 mmol/L) and/or a triglyceride level >250 mg/dL (2.82 mmol/L)
  • women with polycystic ovary syndrome
  • A1C ≥5.7% (39 mmol/mol), IGT, or IFG on previous testing
  • other clinical conditions associated with insulin resistance (e.g., severe obesity, acanthosis nigricans)
  • history of CVD
  • For all patients, testing should begin at age 45 years.
  • If results are normal, testing should be repeated at a minimum of 3-year intervals, with consideration of more frequent testing depending on initial results (e.g., those with prediabetes should be tested yearly) and risk status.

What is the diagnostic criteria for pre-diabetes and diabetes?

Pre-diabetes

FPG 100 mg/dL (5.6 mmol/L) to 125 mg/dL (6.9 mmol/L) (IFG)

OR

2-h PG in the 75-g OGTT 140 mg/dL (7.8 mmol/L) to 199 mg/dL (11.0 mmol/L) (IGT)

OR

A1C 5.7-6.4% (39-46 mmol/mol)

*For all three tests, risk is continuous, extending below the lower limit of the range and becoming disproportionately greater at the higher end of the range.

Diabetes

FPG ≥126 mg/dL (7.0 mmol/L). Fasting is defined as no caloric intake for at least 8 h.*

OR

2-h PG ≥200 mg/dL (11.1 mmol/L) during an OGTT. The test should be performed as described by the WHO, using a glucose load containing the equivalent of 75 g anhydrous glucose dissolved in water.*

OR

A1C ≥6.5% (48 mmol/mol). The test should be performed in a laboratory using a method that is NGSP certified and standardized to the DCTT assay.*

OR

In a patient with classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma glucose ≥200 mg/dL (11.1 mmol/L).

* In the absence of unequivocal hyperglycemia, results should be confirmed by repeat testing.

What are the recommended blood glucose targets for adults with diabetes?

According to the American Diabetes Association (ADA) recommended blood glucose targets for adults (who are non-pregnant) are:

A1C                                                                                     <7.0% (53 mmol/mol)*

Preprandial capillary plasma glucose                      80-130 mg/dL* (4.4-7.2 mmol/L)

Peak postprandial capillary plasma glucose†        <180 mg/dL* (10.0 mmol/L)

*More or less stringent glycemic goals may be appropriate for individual patients. Goals should be individualized based on duration of diabetes, age/life expectancy, comorbid conditions, known CVD or advanced microvascular complications, hypoglycemia unawareness, and individual patient and considerations.

†Postprandial glucose may be targeted if A1C goals are not met despite reaching preprandial glucose goals. Postprandial glucose measurements should be made 1-2 h after the beginning of the meal, generally peak levels in patients with diabetes.

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