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Executive Summary: Standards of Medical Care in Diabetes—2009

Current Criteria for the Diagnosis of Diabetes

  • Fasting plasma glucose (FPG) ≥126 mg/dl (7.0 mmol/l). Fasting is defined as no caloric intake for at least 8 h

  • Symptoms of hyperglycemia and a casual (random) plasma glucose ≥200 mg/dl (11.1 mmol/l). Casual (random) is defined as any time of day without regard to time since last meal. The classic symptoms of hyperglycemia include polyuria, polydipsia, and unexplained weight loss.

  • 2-h plasma glucose ≥200 mg/dl (11.1 mmol/l) during an oral glucose tolerance test (OGTT). The test should be performed as described by the World Health Organization, using a glucose load containing the equivalent of 75 g anhydrous glucose dissolved in water.

Testing for Pre-Diabetes and Diabetes in Asymptomatic Patients

  • Testing to detect pre-diabetes and type 2 diabetes in asymptomatic people should be considered in adults of any age who are overweight or obese (BMI ≥25 kg/m2) and who have one or more additional risk factors for diabetes). In those without these risk factors, testing should begin at age 45 years. (B)

  • If tests are normal, repeat testing should be carried out at least at 3-year intervals. (E)

  • To test for pre-diabetes or diabetes, an FPG test or 2-h OGTT (75-g glucose load) or both are appropriate. (B)

  • An OGTT may be considered in patients with impaired fasting glucose (IFG) to better define the risk of diabetes. (E)

  • In those identified with pre-diabetes, identify and, if appropriate, treat other cardiovascular disease (CVD) risk factors. (B)

Testing for Type 2 Diabetes in Children

  • Test children who are overweight (BMI >85th percentile for age and sex, weight for height >85th percentile, or weight >120% of ideal for height) and have any two of the following risk factors:

    • Family history of type 2 diabetes in first- or second-degree relative

    • Race/ethnicity of Native American, African American, Latino, Asian American, or Pacific Islander

    • Signs of insulin resistance or conditions associated with insulin resistance (acanthosis nigricans, hypertension, dyslipidemia, polycystic ovary …

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