ADA Guidelines: Criteria for Diabetes Diagnosis

The American Diabetes Association recommends the following criteria for diagnosis of diabetes: A1C 6.5%* OR Fasting plasma glucose 126 mg/dL (7.0 mmol/L) OR 2-hour plasma glucose 200 mg/dL (11.1 mmol/L) during an oral glucose tolerance test; 75-g glucose load should be used OR Random plasma glucose concentration 200 mg/dL (11.1 mmol/L) in persons with symptoms of hyperglycemia or hyperglycemic crisis

Test should be performed in a lab using a NGSP-certified method and standardized to the Diabetes Control and Complications Trial (DCCT) assay; In the absence of unequivocal hyperglycemia results should be confirmed using repeat testing; Fasting defined as no caloric intake for 8 hours. ADA Guidelines: Pharmacologic Therapy for Hyperglycemia in Type 2 Diabetes (1 of 2)

Metformin is preferred initial therapy (if tolerated and not contraindicated). Consider insulin therapy with or without other agents at outset in newly diagnosed patients with markedly symptomatic and/or elevated blood glucose levels or A1C. Add second oral agent, GLP-1 receptor agonist, or insulin if noninsulin monotherapy at maximal tolerated dose does not achieve or maintain A1C target over 36 months.

Choice of pharmacologic therapy should be based on a patientcentered approach Consider: o Efficacy o Cost o Potential side effects o Effects on weight o Comorbidities o Hypoglycemia risk o Patient preferences Insulin therapy is eventually needed for many patients due to the progressive nature of type 2 diabetes.