Diagnosis and Assessment Table 3. Testing for Type 2 Diabetes in Asymptomatic Children
ÎCriteria > Overweight (BMI > 85th percentile for age and sex, weight for height > 85th percentile, or weight > 120% of ideal for height) ÎPlus any two of the following risk factors:
> Family history of type 2 diabetes in a first- or second-degree relative > Race/ethnicity (Native American, African American, Latino, Asian American, Pacific Islander)
> Maternal history of diabetes or GDM during the child's gestation ÎFrequency: every 3 years Table 4. Detection and Diagnosis of GDM
ÎScreen for undiagnosed type 2 diabetes at the first prenatal visit in those with risk factors, using standard diagnostic criteria. (B)
ÎIn pregnant women not known to have diabetes, screen for GDM at 24-28 weeks of gestation, using a 75-g 2-h OGTT and the diagnostic cut points in Table 5. (B)
ÎScreen women with GDM for persistent diabetes 6-12 weeks postpartum using a test other than A1c. (E)
ÎWomen with a history of GDM should have lifelong screening for the development of diabetes or prediabetes at least every 3 years. (B)
ÎWomen with a history of GDM found to have prediabetes should receive lifestyle interventions or metformin to prevent diabetes. (A)
Table 5. Screening for and Diagnosis of GDM
ÎPerform a 75-g OGTT, with plasma glucose measurement fasting and at 1 and 2 h, at 24-28 weeks of gestation in women not previously diagnosed with overt diabetes.
ÎThe OGTT should be performed in the morning after an overnight fast of at least 8 h.
ÎThe diagnosis of GDM is made when any of the following plasma glucose values are exceeded:
> Fasting ≥ 92 mg/dL (5.1 mmol/L) > 1 h ≥ 180 mg/dL (10.0 mmol/L) > 2 h ≥ 153 mg/dL (8.5 mmol/L)
2
> Signs of insulin resistance or conditions associated with insulin resistance (acanthosis nigricans, hypertension, dyslipidemia, PCOS, or small-for-gestational-age birth weight)
ÎAge of initiation: 10 years or at onset of puberty if puberty occurs at a younger age
