Executive Summary: Standards of Medical Care in Diabetes—2009

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 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)

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 …