definition, classifi of diabetes and prediabetes
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8102019 Definition Classifi of Diabetes and Prediabetes
httpslidepdfcomreaderfulldefinition-classifi-of-diabetes-and-prediabetes 11
Executive Summary
De1047297nition Classi1047297cation and Diagnosis of Diabetes Prediabetes and Metabolic
Syndrome
KEY MESSAGES
The chronic hyperglycemia of diabetes is associated with signi1047297cant long-term
microvascular and macrovascular complications
A fasting plasma glucose level of 70 mmolL a 2-hour plasma glucose value in
a 75 g oral glucose tolerance test of 111 mmolL or a glycated hemoglobin
(A1C) value of 65 can predict the development of retinopathy This permits
the diagnosis of diabetes to be made on the basis of each of these parameters
The term ldquoprediabetesrdquo refers to impaired fasting glucose impaired glucose
tolerance or an A1C of 60 to 64 each of which places individuals at high risk
of developing diabetes and its complications
Highlights of Revisions
The title of this chapter has been revised to speci1047297cally include ldquoprediabetesrdquo and
ldquometabolic syndromerdquo Since 2008 more data have been published showing the
growing incidence of these conditions and their relation to the prevention and
diagnosis of type 1 and type 2 diabetes
Diabetes can be diagnosed if glycated hemoglobin (A1C) is 65
Prediabetes can be diagnosed with an A1C of 60 to 64
References
1 The DETECT-2 Collaboration Writing Group Glycemic thresholds for diabetes speci1047297c
retinopathy Diabetes Care 201134145e50
2 Santaguida PL Balion C Morrison K et al Diagnosis prognosis and treatment of
impaired glucose tolerance and impaired fasting glucose Evidence reporttech-
nology assessment no 128 Agency Healthcare Research and Quality Publication No
05-E026-2 Rockville MD Agency for Healthcare Research and Quality September
2005
3 Zhang X Gregg E Williamson D et al A1C level and future risk of diabetes
a systematic review Diabetes Care 2010331665e73
RECOMMENDATIONS
1 Diabetes should be diagnosed by any of the following criteria
FPG 70 mmolL [Grade B Level 2 (1)]
A1C 65 (for use in adults in the absence of factors that affect the
accuracy of A1C and not for use in those with suspected type 1 diabetes)
[Grade B Level 2 (1)]
2hPG in a 75 g OGTT 111 mmolL [Grade B Level 2 (1)]
Random PG 111 mmolL [Grade D Consensus]
2 In the absence of symptomatic hyperglycemia if a single laboratory test result
is in the diabetes range a repeat con1047297rmatory laboratory test (FPG A1C 2hPG
in a 75 g OGTT) must be done on another day It is preferable that the same
test be repeated (in a timely fashion) for con1047297rmation but a random PG in the
diabetes range in an asymptomatic individual should be con1047297rmed with an
alternate test In the case of symptomatic hyperglycemia the diagnosis has
been made and a con1047297rmatory test is not required before treatment is initi-
ated In individuals in whom type 1 diabetes is likely (younger or lean or
symptomatic hyperglycemia especially with ketonuria or ketonemia)
con1047297rmatory testing should not delay initiation of treatment to avoid rapid
deterioration If results of two different tests are available and both are above
the diagnostic cutpoints the diagnosis of diabetes is con1047297rmed [Grade D
Consensus]
3 Prediabetes (de1047297ned as a state which places individuals at high risk of devel-
oping diabetes and its complications) is diagnosed by any of the following
criteria IFG (FPG 61e69 mmolL) [Grade A Level 1 (2)]
IGT (2hPG in a 75 g OGTT 78e110 mmolL) [Grade A Level 1 (2)]
A1C 60e64 (for use in adults in the absence of factors that affect the
accuracy of A1C and not for use in suspected type 1 diabetes) [Grade B
Level 2 (3)]
Abbreviations
2hPG 2-hour plasma glucose A1C glycated hemoglobin FPG fasting plasma
glucose IFG impaired fasting glucose IGT impaired glucose tolerance OGTT
oral glucose tolerance test PG plasma glucose
Table 2
Diagnosis of prediabetes
Test Result Prediabetes category
FPG (mmolL) 61e69 IFG
2hPG in a 75-g OGTT (mmolL) 78e110 IGT
A1C () 60e64 Prediabetes
2hPG 2-hour plasma glucose A1C glycated hemoglobin FPG fasting plasma
glucose IFG impaired fasting glucose IGT impaired glucose tolerance OGTT oral
glucose tolerance test
Table 1
Diagnosis of diabetes
FPG Dagger70 mmolL
Fasting frac14 no caloric intake for at least 8 hours
or
A1C Dagger65 (in adults)
Using a standardized validated assay in the absence of factors that affect theaccuracy of the A1C and not for suspected type 1 diabetes (see text)
or
2hPG in a 75 g OGTT Dagger111 mmolL
or
Random PG Dagger111 mmolL
Random frac14 anytime of theday without regardto theinterval since thelast meal
In the absence of symptomatic hyperglycemia if a single laboratory test result is
in thediabetes range a repeat con1047297rmatorylaboratorytest (FPGA1C 2hPGin a 75
gOGTT)mustbedoneonanotherdayItispreferablethatthesametestberepeated
(in a timely fashion) forcon1047297rmation buta randomPG inthe diabetesrange in an
asymptomaticindividual should be con1047297rmed with analternatetest Inthe case of
symptomatichyperglycemiathe diagnosis hasbeen madeand a con1047297rmatorytest
is notrequiredbeforetreatmentis initiatedIn individuals inwhom type1 diabetes
is likely(younger orlean orsymptomatichyperglycemiaespecially withketonuria
or ketonemia) con1047297rmatory testing should not delay initiation of treatment to
avoid rapid deterioration If results of 2 different tests are available and both areabove the diagnostic cutpoints the diagnosis of diabetes is con1047297rmed
2hPG 2-hour plasma glucose A1C glycated hemoglobin FPG fasting plasma
glucose OGTT oral glucose tolerance test PG plasma glucose
Contents lists available at SciVerse ScienceDirect
Canadian Journal of Diabetesj o u r n a l h o m e p a g e
w w w c a n a d i a n j o u r n a l o f d i a b e t e s c o m
1499-2671$ e see front matter 2013 Canadian Diabetes Association
httpdxdoiorg101016jjcjd201302002
Can J Diabetes 37 (2013) S294
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