American Diabetes Association releases Standards of Medical Care in Diabetes- Part 1: Classification and Diagnosis of Diabetes

The American Diabetes Association (ADA) has released Standards of Medical Care in Diabetes. Previously known as Clinical Practice Recommendations, the Standards includes the most current evidence-based recommendations for diagnosing and treating adults and children with all forms of diabetes.

Key Messages:

PROMOTING HEALTH AND REDUCING DISPARITIES IN POPULATIONS

Recommendations

  • Treatment plans should align with the Chronic Care Model, emphasizing productive interactions between a prepared proactive practice team and an informed activated patient.
  • When feasible, care systems should support team-based care, community involvement, patient registries, and decision support tools to meet patient needs.

CLASSIFICATION AND DIAGNOSIS OF DIABETES

Diabetes can be classified into the following general categories:

  1. Type 1 diabetes (due to autoimmune β-cell destruction, usually leading to absolute insulin deficiency)
  2. Type 2 diabetes (due to a progressive loss of β-cell insulin secretion frequently on the background of insulin resistance)
  3. Gestational diabetes mellitus (GDM) (diabetes diagnosed in the second or third trimester of pregnancy that is not clearly overt diabetes prior to gestation)
  4. Other specific types, including monogenic forms of diabetes

Diagnostic Tests for Diabetes

Diabetes may be diagnosed based on plasma glucose criteria—

  • either the fasting plasma glucose (FPG) or
  • 2-h plasma glucose value after a 75-g oral glucose tolerance test (OGTT) or
  • A1C (Table 1).

table-1-criteria-for-the-diagnosis-of-diabetes

The same tests are used to screen for and diagnose diabetes and to detect individuals with prediabetes (Table 2).

table-2-criteria-for-testing-for-diabetes-or-prediabetes-in-asymptomatic-adults

Prediabetes is defined as

  • Fasting Plasma Glucose (FPG) of 100–125 mg/dL (5.6–6.9 mmol/L);
  • 2-hr Oral Glucose Tolerance Test (OGTT) of 140–199 mg/dL (7.8–11.0 mmol/L); or
  • A1C of 5.7–6.4% (39–47 mmol/mol).

Type 2 Diabetes and Prediabetes

Recommendations

  • Screening to assess prediabetes and risk for future diabetes with an informal assessment of risk factors or validated tools should be considered in asymptomatic adults.
  • To test for prediabetes, FPG, OGTT, and A1C are equally appropriate.
  • Testing for prediabetes and type 2 diabetes should be considered in children and adolescents who are overweight or obese and who have two or more additional risk factors for diabetes.

Useful Links:

Link to the American Diabetes Association news release:

http://www.diabetes.org/newsroom/press-releases/2016/american-diabetes-2017-standards-of-care.html?referrer=https://www.google.co.in/?referrer=http://www.diabetes.org/newsroom/press-releases/2016/american-diabetes-2017-standards-of-care.html

Link to the new guidelines (English) [PDF]:

http://professional.diabetes.org/sites/professional.diabetes.org/files/media/dc_40_s1_final.pdf

Link to the ADA website:

http://www.diabetes.org/?referrer=https://www.google.com/

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