Consider testing if person is:– Overweight or obese with additional risk factor for

diabetes– Age 45 or older

Obtain: A1C or FPG or 2-hour plasma glucose post 75g OGTT

Repeat testing every 3 years if results are normal

In patients with increased risk, identify and treat other CVD risk factors

American Diabetes Association. Diabetes Care 2010; 33;(Suppl1).

Objective: To determine if A1C is an optimal method for diagnosing diabetes and detecting pre-diabetes compared to IFG and IGT

Results:◦ Detection of pre-diabetes

IFG: 69.1% IGT: 59.5% A1C: 23.6%

Conclusion:  A1C is less sensitive for detecting pre-diabetic individuals than IFG and IGT

Lorenzo et al. Diab Care. 2010 June 23. Epub ahead of print.

A1C Fasting Plasma Glucose Test

(FPG)

2-Hour Oral Glucose

Challenge

Acceptable ≤5.6% Below 100 mg/dl Below 140 mg/dl

Pre-Diabetes

5.7% - 6.4% 100-125 mg/dl (IFG)

140-199 mg/dl (IGT)

Diabetes ≥ 6.5% 126 mg/dl or above

200 mg/dl or above

American Diabetes Association. Diabetes Care 2010; 33;(Suppl.1):S11-61.

.

43% 37% 19% 14%16% 12%

*P<0.05; †P<0.0001.

Stratton IM, et al. BMJ. 2000;321(7258):405-412.

Lower-extremity

amputation or fatal

peripheral vascular disease†

Microvascular disease†

Cataract extraction†

Myocardial infarction†Heart

failure* Stroke*

Cardiovascular complications

*Multivariate regression – adjusted for age and risk factor; †Multivariate regression – adjusted for age, sex, and risk factor.EPIC-Norfolk: The European Prospective Investigation into Cancer in Norfolk was a prospective population study of 4,662 men and 5,570 women aged 45-79 years. Average follow-up time was 6.3 years.Khaw KT et al. Ann Intern Med. 2004;141:413-420.

1% Increase in A1C Above 5% 1% Increase in A1C Above 7%

CHD CVD TotalMortalit

y

0

10

20

30

4040%

16%

26%

Men

0

5

10

15

20

25

30

Total Mortalit

y

CHD CVD

21%24%25%

Total Mortalit

y

CHD CVD

Women

21%

28%

20%