Diagnosis and Prevention
3
➤ In patients aged 65 years and older without known diabetes who meet the
criteria for prediabetes (see Table 1) by fasting plasma glucose or HbA1c,
ES suggests obtaining a 2-hour glucose post oral glucose tolerance test
measurement. (2|⊕⊕⊕
)
Technical Remarks:
▶ This recommendation is most applicable to high-risk patients with any of the
following characteristics: overweight or obese, first-degree relative with diabetes,
high-risk race/ethnicity (e.g., African American, Latino, Native American, Asian
American, Pacific Islander), history of CVD, hypertension (≥140/90 mmHg or
on therapy for hypertension), high-density lipoprotein (HDL) cholesterol level
<35 mg/dL (0.90 mmol/L) and/or a triglyceride level >250 mg/dL (2.82 mmol/L),
sleep apnea, or physical inactivity.
▶ Shared decision-making is advised for performing this procedure in frail older people
or in those for whom it may be overly burdensome.
▶ Standard dietary preparation for an oral glucose tolerance test is advised.
➤ In patients aged 65 years and older who have prediabetes, ES recommends
a lifestyle program similar to the Diabetes Prevention Program to delay
progression to diabetes. (1|⊕⊕⊕⊕)
Technical Remarks:
▶ Metformin is not recommended for diabetes prevention at this time, as it is not
approved by the FDA for this indication.
▶ As of 2018, a Diabetes Prevention Program-like lifestyle intervention is a covered
benefit for Medicare beneficiaries in the US who meet the criteria for prediabetes (see
Table 1).
Table 1. ADA Criteria for Diabetes and Prediabetes
Prediabetes
a
Diabetes
b
FPG 100 mg/dL (5.6 mmol/L)
to 125 mg/dL (6.9 mmol/L) = IFG
FPG ≥126 mg/dL (7.0 mmol/L)
OR OR
2-h PG during 75-g OGTT 140 mg/dL
(7.8 mmol/L) to 199 mg/dL (11.0 mmol/L) = IGT
2-h PG ≥200 mg/dL (11.1 mmol/L)
during OGTT
c
OR OR
A1C 5.7%–6.4% (39–47 mmol/mol)
d
A1C ≥6.5% (48 mmol/mol)
d
In a patient with classic symptoms
of hyperglycemia or hyperglycemic
crisis, a random PG ≥200 mg/dL
(11.1 mmol/L).
a
For all three tests, risk is continuous, extending below the lower limit of the range and becoming
disproportionately greater at the higher end of the range.
b
In the absence of unequivocal hyperglycemia, diagnosis requires two abnormal test results from the
same sample or in two separate test samples.
c
e 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.
d
e test should be performed in a laboratory using a method that is National Glycohemoglobin
Standardization Program certified and standardized to the Diabetes Control and Complications Trial assay.
[Data from American Diabetes Association. 2. Classification and diagnosis of diabetes: standards of
medical care in diabetes-2019. Diabetes Care. 2019;42:S13–s28].
