Classification and Diagnosis of Diabetes

2016 ADA Guideline Recommendations
Types of Diabetes Mellitus
Main Diabetes Page
Diabetes type I
Diabetes type II
Gestational Diabetes Mellitus
2016 ADA Standard of Medical Care Guideline Recommendations
Strategies for Improving Care
Classification and Diagnosis of Diabetes
Foundations of Care and Comprehensive Medical Evaluation Diabetes Self-Management, Education, and Support Nutritional Therapy
Prevention or Delay of Type II Diabetes
Glycemic Targets
Obesity Management for Treatment of Type II Diabetes
Approaches to Glycemic Treatment
Cardiovascular Disease and Risk Management Hypertension and Blood Pressure Control Lipid Management Antiplatelet Agents Coronary Heart Disease
Microvascular Complications and Foot Care Diabetic Kidney Disease Diabetic Retinopathy Diabetic Neuropathy Diabetic Footcare
Older Adults with Diabetes
Children and Adolescents with Diabetes Management of Cardiovascular Risk Factors in Children and Adolescents with Diabetes Microvascular Complications in Children and Adolescents with Diabetes
Management of Diabetes in Pregnancy
Diabetes Care in the Hospital Setting

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shivani Chaparala M.B.B.S [2]; Seyedmahdi Pahlavani, M.D. [3]; Tarek Nafee, M.D. [4]

2016 ADA Standards of Medical Care in Diabetes Guidelines

Categories of Increased risk for diabetes (PREDIABETES)

"1. Testing to assess risk for future di- abetes in asymptomatic people should be considered in adults of any age who are overweight or obese (BMI $25 kg/m2 or $23 kg/m2 in Asian Americans) and who have one or more additional risk factors for diabetes. (Level of Evidence: B)"

"2. For all patients, testing should begin at age 45 years (Level of Evidence: B)"

"3. If tests are normal, repeat testing carried out at a minimum of 3-year intervals is reasonable. (Level of Evidence: C)"

"4. To test for prediabetes, fasting plasma glucose, 2-h plasma glucose after 75-g oral glucose tolerance test, and A1C are equally appropriate. (Level of Evidence: B)"

"5. In patients with prediabetes, iden- tify and, if appropriate, treat other cardiovascular disease risk factors. (Level of Evidence: A)"

"6. Testing to detect prediabetes should be considered in children and ado- lescents who are overweight or obese and who have two or more additional risk factors for diabetes (Level of Evidence: E)"

TYPE 1 DIABETES

"1. Blood glucose rather than A1C should be used to diagnose acute onset of type 1 diabetes in individuals with symptoms of hyperglycemia. (Level of Evidence: E)"

"2. Inform the relatives of patients with type 1 diabetes of the opportunity to be tested for type 1 diabetes risk, but only in the setting of a clinical research study. (Level of Evidence:E)"

TYPE 2 DIABETES

"1. Testing to detect type 2 diabetes in asymptomatic people should be con- sidered in adults of any age who are overweight or obese (BMI $25 kg/m2 or $23 kg/m2 in Asian Amer- icans) and who have one or more additional risk factors for diabetes. (Level of Evidence: B)"

"2. For all patients, testing should be- gin at age 45 years. (Level of Evidence: B)"

"3. If tests are normal, repeat testing carried out at a minimum of 3-year intervals is reasonable. (Level of Evidence: C)"

"4. To test for type 2 diabetes, fasting plasma glucose, 2-h plasma glucose after 75-g oral glucose tolerance test, and A1C are equally appropriate. (Level of Evidence: B)"

"5. In patients with diabetes, identify and, if appropriate, treat other cardiovascular disease risk factors. (Level of Evidence: B)"

"6. Testing to detect prediabetes should be considered in children and ado- lescents who are overweight or obese and who have two or more additional risk factors for diabetes (Level of Evidence: E)"

GESTATIONAL DIABETES MELLITUS

"1. Test for undiagnosed type 2 diabe- tes at the first prenatal visit in those with risk factors, using stan- dard diagnostic criteria. (Level of Evidence: B)"

"2. Test for gestational diabetes mel- litus at 24–28 weeks of gestation in pregnant women not previously known to have diabetes. (Level of Evidence: B)"

"3. Screen women with gestational di- abetes mellitus for persistent diabe- tes at 6–12 weeks postpartum,using the oral glucose tolerance test and clinically appropriate non- pregnancy diagnostic criteria. (Level of Evidence: E)"

"4. Women with a history of gesta- tional diabetes mellitus should have lifelong screening for the de- velopment of diabetes or predia- betes at least every 3 years. (Level of Evidence: B)"

"5. Women with a history of gesta- tional diabetes mellitus found to have prediabetes should receive lifestyle interventions or metfor- min to prevent diabetes. (Level of Evidence: A)"

MONOGENIC DIABETES SYNDROMES

"1. All children diagnosed with diabe- tes in the first 6 months of life should have genetic testing. (Level of Evidence: B)"

"2.Maturity-onset diabetes of the young should be considered in individuals who have mild stable fasting hyperglycemia and multiple family members with diabetes not characteristic of type 1 or type 2 diabetes(Level of Evidence: E)"

"3.Because a diagnosis of maturity- onset diabetes of the young may impact therapy and lead to identi- fication of other affected family members, consider referring indi- viduals with diabetes not typical of type 1 or type 2 diabetes and oc- curing in successive generations (suggestive of an autosomal dom- inant pattern of inheritance) to a specialist for further evaluation. (Level of Evidence: E)"

CYSTIC FIBROSIS-RELATED DIABETES

"1. Annual screening for cystic fibrosis– related diabetes with oral glucose tolerance test should begin by age 10 years in all patients with cystic fibrosis who do not have cystic fibrosis–related diabetes. (Level of Evidence: B)"

"2. A1C as a screening test for cystic fibrosis–related diabetes is not recommended. (Level of Evidence: B)"

"3. Patients with cystic fibrosis–related diabetes should be treated with insulin to attain individualized gly- comic goals. (Level of Evidence: A)"

"4. In patients with cystic fibrosis and impaired glucose tolerance with- out confirmed diabetes, prandial insulin therapy should be consid- ered to maintain weight. (Level of Evidence: B)"

"5. Beginning 5 years after the diagnosis of cystic fibrosis–related diabetes, annual monitoring for complications of diabetes is recommended. (Level of Evidence: E)"