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