Use the criteria below to diagnose type 2 diabetes in non-pregnant patients:
Hemoglobin A1C (A1C) ≥ 6.5%; or
Fasting plasma glucose (FPG) ≥ 126 mg/dL, where FPG is defined as no caloric intake for at least 8 hours; or
2-hour oral glucose tolerance test (OGTT) ≥ 200 mg/dL; or
Casual plasma glucose ≥ 200 mg/dL with symptoms of hyperglycemia, where “casual” is defined as any time of day without regard to time of last meal.
In the absence of unequivocal hyperglycemia, confirm a positive result by repeat testing on a different day.
→ Note: While it is acceptable to screen for diabetes using a point-of-care (POC) capillary A1C and/or glucose, diabetes should only be diagnosed using laboratory-run tests. In addition, the A1C test alone may be less accurate when used to diagnose diabetes in youth.
Categories of Increased Risk for Diabetes (Prediabetes)
Last updated: August 2012
Recommendations for Identifying Patients at Increased Risk for Diabetes
Use the following criteria to identify patients at increased risk for diabetes:
Impaired fasting glucose (IFG) defined as FPG 100-125 mg/dL (if positive, consider obtaining a second test to confirm prediabetes), or
Impaired glucose tolerance (IGT) defined as 2-hour OGTT 140-199 mg/dL (if positive, consider obtaining a second test to confirm prediabetes)
A1C may be used as a screening test. If the result is 5.7-6.4%, perform either a FPG or an OGTT to confirm a diagnosis of prediabetes.
Patients with blood glucose levels higher than normal but not high enough to be considered diabetes are at increased risk for developing diabetes. Patients with either impaired fasting glucose or impaired glucose tolerance have been referred to as having “prediabetes.” Providers are encouraged to identify patients at increased risk for diabetes so they can start or intensify efforts to prevent progression to diabetes. Diabetes prevention programs for these patients are available in many AI/AN communities.
→ Note: The American Diabetes Association (ADA) criteria include use of the A1C alone to identify prediabetes. However, all other major standard-setting diabetes organizations do not recommend using the A1C test alone to identify patients with prediabetes.
Testing for Diabetes/Prediabetes in Non-pregnant Asymptomatic AI/AN People
Last updated: July 2012
Recommendations for Testing for Diabetes/Prediabetes in AI/AN Adults
Test AI/AN adults at least every 3 years.
Consider testing more frequently in patients with additional risk factors, including:
Overweight/obese (Body Mass Index [BMI] ≥ 25 kg/m2)
Family history of type 2 diabetes in first degree relative
History of gestational diabetes (GDM) or delivery of a baby weighing > 9 pounds
Recommendations for Testing for Diabetes/Prediabetes in AI/AN Youth
Test overweight AI/AN youth (BMI > 85th percentile) with any of the following risk factors:
Family history of diabetes
Signs of insulin resistance or conditions associated with it [e.g., acanthosis nigricans, polycycstic ovarian syndrome (PCOS), hypertension, dyslipidemia, small-for-gestational-age (SGA), or large-for-gestational-age (LGA) birth weight]
Maternal history of diabetes or gestational diabetes during child’s gestation.
Start testing at-risk children at age 10 years (or younger if puberty occurs earlier).
Test at-risk children ≤ every 3 years.
→ Note: In patients who present with hyperglycemic symptoms, testing for diabetes is warranted regardless of risk factors listed above.
American Diabetes Association. Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 2012 Jan;35(Suppl 1):S64-71.
Pogach L, Conlin PR, Hobbs C, Vigersky RA, Aron D. VA-DoD update of diabetes guidelines: what clinicians need to know about absolute risk of benefits and harms and A1C laboratory accuracy. Fed Pract. 2011;28(4):39-44. (Note, it is already in the bibliography section)
Healthy Native Communities Partnership Inc. (HNCP).
Native Lifestyle Balance.
Modified, Native American versions of the lifestyle intervention manuals and curriculum used in the NIH Diabetes Prevention Program (DPP) study. Native Lifestyle Balance Core Manual. Manual includes the tools needed to provide the 16 Core sessions of the NLB curriculum.
This special issue focuses on preventing type 2 diabetes and strategies for reducing risk with stories about lifestyle changes made by the participants of the Diabetes Prevention Program study. 39 pages.
Pogach L, Conlin PR, Hobbs C, Vigersky RA, Aron D. VA-DoD update of diabetes guidelines: what clinicians need to know about absolute risk of benefits and harms and A1C laboratory accuracy. Fed Pract. 2011;28(4):39-44.
Tabák AG, Herder C, Rathmann W, Brunner EJ, Kivimäki M. Lancet. Published online June 9, 2012 DOI:10.1016/S0140-6736(12)60283-9.