Executive Summary: Standards of Medical Care in Diabetes—2010

Current criteria for the diagnosis of diabetes

  • A1C ≥6.5%: The test should be performed in a laboratory using a method that is National Glycohemoglobin Standardization Program (NGSP) certified and standardized to the Diabetes Control and Complications Trial (DCCT) assay.

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

  • 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.

  • In a patient with classic symptoms of hyperglycemia or hyperglycemic crisis: a random plasma glucose ≥200 mg/dl (11.1 mmol/l).

Testing for diabetes in asymptomatic patients

  • Testing to detect type 2 diabetes and 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) and who have one or more additional risk factors for diabetes (see Table 4 of Standards of Medical Care in Diabetes—2010). 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 diabetes or to assess risk of future diabetes, A1C, FPG, or 2-h 75-g OGTT are appropriate. (B)

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

Detection and diagnosis of gestational diabetes mellitus

  • Screen for gestational diabetes mellitus (GDM) using risk-factor analysis and, if appropriate, the OGTT. (C)

  • Women with GDM should be screened for diabetes 6–12 weeks postpartum and should be followed up with subsequent screening for the development of diabetes or pre-diabetes. (E)

Prevention of type 2 diabetes

  • Patients with IGT (A), IFG (E), or an A1C of 5.7–6.4% (E) should be referred to an effective ongoing support program for weight loss of …

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