Diabetes Standards of Care and Resources for Clinicians and Educators
Diagnosing Type 2 Diabetes and Identifying Prediabetes
The American Diabetes Association and the World Health Organization have established uniform criteria for diagnosing type 2 diabetes and identifying people with prediabetes. Type 2 diabetes can be diagnosed in one of four ways: measuring A1C, fasting plasma glucose, and random plasma glucose levels or performing an oral glucose tolerance test. Risk assessment tools are available to determine whether an individual should be tested for diabetes or prediabetes.
Clinical Practice Recommendations
Recommendations for Diagnosing Type 2 Diabetes and Identifying Prediabetes
Diabetes risk assessment tools can be used to identify asymptomatic individuals at increased risk for diabetes, and determine if a diagnostic test should be performed.
- 60-Second Type 2 Diabetes Risk Test Exit Disclaimer: You Are Leaving www.ihs.gov of the American Diabetes Association, which can also be accessed with the Diabetes Risk Test Exit Disclaimer: You Are Leaving www.ihs.gov from the National Institute of Diabetes and Digestive and Kidney Diseases
- Prediabetes Risk Test Exit Disclaimer: You Are Leaving www.ihs.gov of the Centers for Disease Control and Prevention
Use one of the criteria below to diagnose type 2 diabetes in non-pregnant people:
- A1C level of 6.5% or higher
- Fasting plasma glucose (FPG) level of 126 mg/dL or higher, after the person has had no caloric intake overnight for at least 8 hours
- 2-hour plasma glucose (PG) level of 200 mg/dL or higher with a 75-gm oral glucose tolerance test
- Random plasma glucose test result of 200 mg/dL or higher in people with symptoms of hyperglycemia, such as increased thirst, increased urination, unexplained weight loss, fatigue, or blurred vision
Two abnormal results from the same or different tests are required for diagnosis (e.g. two A1C levels ≥ 6.5% or an A1C value ≥ 6.5% and an FPG test result ≥ 126 mg/dL). However, a single random test result of 200 mg/dL or higher in a person with symptoms is diagnostic for diabetes.
Although point-of-care capillary A1C and/or glucose tests can be used to screen people for diabetes, only laboratory-run tests should be used for diagnosis.
People with prediabetes have blood glucose levels that are above the normal range but not elevated to meet the criteria for diabetes. An individual with prediabetes may also have other risk factors related to diabetes such as obesity, abnormal blood lipid levels, and high blood pressure.
Use any one of the following criteria to identify people with prediabetes.
- A1C level of 5.7% to 6.4%
- Fasting plasma glucose level of 100 mg/dL to 125 mg/dL
- 2-hour plasma glucose value of 140 mg/dL to 199 mg/dL during a 75-gm oral glucose tolerance test
Test for diabetes in asymptomatic adults, and then every 3 years thereafter.
Consider testing adults more often if they have additional risk factors (such as those listed below):
- Overweight/obese (body mass index [BMI] ≥ 25 kg/m2)
- Physical inactivity
- Type 2 diabetes in a first-degree relative
- History of gestational diabetes
- History of cardiovascular disease
- Signs of insulin resistance or conditions associated with it (e.g., acanthosis nigricans, polycystic ovarian syndrome, hypertension, or dyslipidemia with HDL cholesterol level lower than 35 mg/dL and/or triglycerides level higher than 250 mg/dL)
Test people with prediabetes for diabetes each year.
Test overweight and obese youth (those with a BMI in the 85th percentile or higher) at the onset of puberty or after age 10 years (whichever comes first), and then every 3 years thereafter.
Consider testing children and adolescents more frequently if they have additional risk factors, such as:
- Increasing BMI over time
- Maternal history of diabetes or gestational diabetes during the child's gestation
- Family history of diabetes
- Signs of insulin resistance or conditions associated with it (e.g., acanthosis nigricans, polycystic ovarian syndrome, hypertension, dyslipidemia, or small-for-gestational-age birth weight)
Test children and adolescents with prediabetes for diabetes each year.
Clinician and Educator Resources
Featured Diagnosing Type 2 Diabetes and Identifying Prediabetes Resources
Diabetes Treatment Algorithm:
Diabetes Education Lesson Plan:
American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Care in Diabetes 2023 Exit Disclaimer: You Are Leaving www.ihs.gov Diabetes Care 2023;46(Suppl. 1):S19-S40. doi:10.2337/dc23-S002
Patient Education Resources
Diagnosing Type 2 Diabetes and Identifying Prediabetes CME Trainings
|Session Title||Session Material||CME/CE Information|
New Insulin Resistance: Explanations and Treatment Approaches Exit Disclaimer: You Are Leaving www.ihs.govRachel Blair, MD
Associate Physician and Instructor of Medicine
Margo Hudson, MD
Associate Physician and Assistant Professor of Medicine
Brigham and Women’s Hospital, Harvard Medical School
(Originally presented on 07/05/23)
|Diabetes Prevention Strategies: Evidence, Experiences, and Outcomes Exit Disclaimer: You Are Leaving www.ihs.gov
Richard Arakaki, MD
University of Hawaii
(Originally presented on 8/11/21.)