ÎÎPrediabetes can be identified by the presence of impaired glucose
tolerance, which is an OGTT glucose value of 140 to 199 mg/dL
2 hours after ingesting 75 g of glucose and/or impaired fasting
glucose, which is a fasting glucose value of 100 to 125 mg/dL
(Table 1) (D-4).
>> HbA1c values between 5.5% and 6.4% should be a signal to do more specific glucose
testing (D-4).
>> HbA1c testing should be used as a screening tool only; FPG measurement or an
OGTT should be used for definitive diagnosis (D-4).
>> Metabolic syndrome based on National Cholesterol Education Program IV Adult
Treatment Panel III criteria is a prediabetes equivalent (C-3).
ÎÎThere is a continuum of risk for poor patient outcomes in the
progression from normal glucose tolerance to overt T2DM (D-4).
ÎÎThe following criteria may be used to diagnose DM (Table 1) (A-1):
>> FPG concentration (after 8 or more hours of no caloric intake) ≥ 126 mg/dL OR
>> Plasma glucose concentration of ≥ 200 mg/dL 2 hours after ingesting 75-g oral
glucose load in the morning after an overnight fast of at least 8 hours OR
>> Symptoms of uncontrolled hyperglycemia (eg, polyuria, polydipsia, polyphagia)
and a random (casual, nonfasting) plasma glucose concentration ≥ 200 mg/dL OR
>> HbA1c level of 6.5% or higher.
ÎIn pregnancy, elevated plasma glucose levels (FPG concentration
Î
> 92 mg/dL; 1-hour postchallenge glucose value ≥ 180 mg/dL; or 2-hour
value ≥ 153 mg/dL) satisfy the criteria for a diagnosis of GDM (C-3).
>> All pregnant women should be screened for GDM at 24 to 28 weeks' gestation
using a 75-g (glucose), 2-hour OGTT.
Related Conditions
Asymptomatic Coronary Artery Disease
ÎÎMeasurement of coronary artery calcification or coronary imaging
may be used to assess whether a patient is a reasonable candidate for
intensification of glycemic, lipid, and/or blood pressure control (C-3).
ÎÎScreening for asymptomatic coronary artery disease with various stress
tests in patients with T2DM has not been clearly demonstrated to
improve cardiac outcomes and is therefore NOT recommended (D-4).
Sleep-Related Problems
ÎÎObstructive sleep apnea is common and should be screened for in
adults with T2DM, especially in men older than 50 years (D-4).
ÎÎContinuous positive airway pressure should be considered for treating
patients with obstructive sleep apnea (A-1).
Note: This condition can be diagnosed by history or by home monitoring, but referral
to a sleep specialist should be considered in patients suspected of having obstructive
sleep apnea or restless leg syndrome (D-4).
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