U.S. Department of Health and Human Services
Indian Health Service: The Federal Health Program for American Indians and Alaska Natives
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Thursday, July 24, 2014

Division of Diabetes Treatment and Prevention - Leading the effort to treat and prevent diabetes in American Indians and Alaska Natives


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Diabetes Diagnosis

Glucose Control Algorithm Card
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NOTE: Access to this information is not restricted; however, the information found here is intended for use by medical providers. Some videos contain graphic images. Patients should talk with their medical providers about any specific concerns.

The IHS Division of Diabetes supports the ADA recommendations for the diagnosis of type 2 diabetes.

There are four methods to dx diabetes; for methods one through three, unless unequivocal hyperglycemia, confirm dx with a second test on a separate day:

  • A1C ≥6.5% (preferred method)
  • Fasting plasma glucose ≥126 mg/dL
  • 2-hour plasma glucose ≥200 mg/dL during an oral glucose tolerance test (OGTT) using a 75 g oral glucose load
  • Random plasma glucose ≥200 mg/dL plus symptoms of diabetes: e.g., polyuria, polydypsia, or unexplained weight loss

Categories of Increased Risk for Diabetes (“Prediabetes”) are defined as any of the following:

  • A1C 5.7 to 6.4%
  • Fasting plasma glucose 100-125 mg/dL
  • 2-hour plasma glucose of 140-199 mg/dL during a 75 g OGTT

How to use A1C for diagnosis:

  • Ensure that A1C is clearly and accurately listed in EHR or other local medical record.
  • Can screen with a point of care (POC) A1C test, however ADA recommends that laboratory-run tests be used to diagnose diabetes.
  • If A1C test is ≥6.5%, repeat A1C test to confirm.
  • If get two tests (e.g. A1C and FPG) and one is in the diagnostic range and the other isn’t, what do you do?
    • Repeat the test which was in the diagnostic range and base the diagnostic decision on the basis of the confirmed test.
  • If get two tests (e.g. A1C and FPG) and both are significantly elevated, it's not necessary to confirm with a repeat test of either if it fits the clinical picture.

When not to use A1C for diagnosis:

  • Hemoglobinopathies—HbS, HbC, HbF, HbE may interfere with some A1C assays.
  • Variation in red blood cell lifespan (e.g. hemolysis, blood loss, blood transfusions).

Who should be tested for diabetes/prediabetes (non-pregnant asymptomatic patients)

  • Adults: overweight or obese (BMI ≥25) and/or strong family history of type 2 diabetes in 1st or 2nd degree relative and/or history of gestational diabetes (GDM).
  • Children: >10 years of age (or earlier if entered puberty)
    • If BMI >85th %ile and any of the following:
      • Family history of type 2 diabetes in 1st or 2nd degree relative, or
      • Presence of a condition associated with insulin resistance [Acanthosis nigricans, Hypertension, Dyslipidemia, Polycycstic Ovarian Syndrome (PCOS)], or
      • Maternal history of pre-existing or gestational diabetes during child’s gestation

       

Overview How To Other Resources

Division of Diabetes Treatment and Prevention | Phone: (505) 248-4182 | Fax: (505) 248-4188 | diabetesprogram@ihs.gov