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Executive Summary: Standards of Medical Care in Diabetes—2010
Current criteria for the diagnosis of diabetes ● A1C 6.5%: The test should be performed in a laboratory using a method that is National Glycohemoglobin Standardization Program (NGSP) certified and standardized to the Diabetes Control and Complications Trial (DCCT) assay. ● FPG 126 mg/dl (7.0mmol/l): Fasting is defined as no caloric intake for at least 8 h. ● 2-h plasma glucose 200 mg/dl (11.1 mmol/l) during an oral glucose tolerance test (OGTT): The 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. ● In a patient with classic symptoms of hyperglycemia or hyperglycemic crisis: arandom plasma glucose 200 mg/dl (11.1 mmol/l). Testing for diabetes in asymptomatic patients ● Testing to detect type 2 diabetes and assess risk for future diabetes in asymptomatic people should be considered in adults of any age who are overweight or obese (BMI 25 kg/m2) and who have one or more additional risk factors for diabetes (see Table 4 of Standards of Medical Care in Diabetes—2010). Inthose without these risk factors, testing should begin at age 45 years. (B) ● If tests are normal, repeat testing should be carried out at least at 3-year intervals. (E) ● To test for diabetes or to assess risk of future diabetes, A1C, FPG , or 2-h 75-g OGTT are appropriate. (B) ● In those identified with increased risk for future diabetes, identify and, if appropriate, treat other cardiovasculardisease (CVD) risk factors. (B) Detection and diagnosis of gestational diabetes mellitus ● Screen for gestational diabetes mellitus (GDM) using risk-factor analysis and, if appropriate, the OGTT. (C) ● Women with GDM should be screened for diabetes 6 –12 weeks postpartum and should be followed up with subsequent screening for the development of diabetes or pre-diabetes. (E) Prevention of type 2diabetes Patients with IGT (A), IFG (E), or an A1C of 5.7– 6.4% (E) should be referred to an effective ongoing support program for weight loss of 5–10% of body weight and increase in physical activity to at least 150 min/week of moderate activity such as walking. ● Follow-up counseling appears to be important for success. (B) ● Based on potential cost savings of diabetes prevention, such counselingshould be covered by third-party payors. (E) ● In addition to lifestyle counseling, metformin may be considered in those who are at very high risk for developing diabetes (combined IFG and IGT plus other risk factors such as A1C 6%, hypertension, low HDL cholesterol, elevated triglycerides, or family history of diabetes in a first-degree relative) and who are obese and under 60 years of age. (E) ●Monitoring for the development of diabetes in those with pre-diabetes should be performed every year. (E)

medical nutrition therapy (MNT) alone, SMBG may be useful as a guide to the success of therapy. (E) To achieve postprandial glucose targets, postprandial SMBG may be appropriate. (E) When prescribing SMBG, ensure that patients receive initial instruction in, androutine follow-up evaluation of, SMBG technique and their ability to use data to adjust therapy. (E) Continuous glucose monitoring (CGM) in conjunction with intensive insulin regimens can be a useful tool to lower A1C in selected adults (age 25 years) with type 1 diabetes. (A) Although the evidence for A1Clowering is less strong in children, teens, and younger adults, CGM may be helpful in thesegroups. Success correlates with adherence to ongoing use of the device. (C) CGM may be a supplemental tool to SMBG in those with hypoglycemia unawareness and/or frequent hypoglycemic episodes. (E)

A1C Perform the A1C test at least two times a year in patients who are meeting treatment goals (and who have stable glycemic control). (E) ● Perform the A1C test quarterly in patients whose therapy has...
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