The evidence grading system (A through C, E) is defined at the end of the "Major Recommendations" field.
Testing for Pre-diabetes and Diabetes in Asymptomatic Patients
- Testing to detect pre-diabetes and type 2 diabetes in asymptomatic people should be considered in adults who are overweight or obese (body mass index [BMI] >25 kg/m2) and who have one or more additional risk factors for diabetes. In those without these risk factors, testing should begin at age 45. (B)
- If tests are normal, repeat testing should be carried out at least at 3-year intervals. (E)
- To test for pre-diabetes or diabetes, either a fasting plasma glucose (FPG) test or a 2-h oral glucose tolerance test (OGTT) (75-g glucose load) or both are appropriate. (B)
- An oral glucose tolerance test may be considered in patients with impaired fasting glucose (IFG) to better define the risk of diabetes. (E)
- In those identified with pre-diabetes, identify and, if appropriate, treat other cardiovascular disease (CVD) risk factors. (B)
Criteria for Testing for Pre-Diabetes and Diabetes in Asymptomatic Adult Individuals
| 1. |
Testing should be considered in all adults who are overweight (BMI >25 kg/m2*) and have additional risk factors:
- Physical inactivity
- First-degree relative with diabetes
- Members of a high-risk ethnic population (e.g., African American, Latino, Native American, Asian American, and Pacific Islander)
- Women who delivered a baby weighing >9 lb or have been diagnosed with gestational diabetes mellitus (GDM)
- Hypertension (>140/90 mmHg or on therapy for hypertension)
- High-density lipoprotein (HDL) cholesterol level <35 mg/dL (0.90 mmol/L) and/or a triglyceride level >250 mg/dL (2.82 mmol/L)
- Women with polycystic ovarian syndrome (PCOS)
- Impaired glucose tolerance (IGT) or IFG on previous testing
- Other clinical conditions associated with insulin resistance (e.g., severe obesity and acanthosis nigricans)
- History of CVD
|
| 2. |
In the absence of the above criteria, testing for pre-diabetes and diabetes should begin at age 45 years |
| 3. |
If results are normal, testing should be repeated at least at 3-year intervals, with consideration of more frequent testing depending on initial results and risk status. |
*At-risk BMI may be lower in some ethnic groups.
Testing for Type 2 Diabetes in Asymptomatic Children
| Criteria |
|
| Age of initiation |
Age 10 years or at onset of puberty, if puberty occurs at a younger age |
| Frequency |
Every 2 years |
| Test |
FPG preferred |
Definitions:
American Diabetes Association's Evidence Grading System for Clinical Practice Recommendations
A
Clear evidence from well-conducted, generalizable, randomized controlled trials that are adequately powered, including:
- Evidence from a well-conducted multicenter trial
- Evidence from a meta-analysis that incorporated quality ratings in the analysis
- Compelling non-experimental evidence (i.e., "all or none" rule developed by the Center for Evidence Based Medicine at Oxford*)
Supportive evidence from well-conducted randomized, controlled trials that are adequately powered, including:
- Evidence from a well-conducted trial at one or more institutions
- Evidence from a meta-analysis that incorporated quality ratings in the analysis
*Either all patients died before therapy and at least some survived with therapy, or some patients died without therapy and none died with therapy. Example: use of insulin in the treatment of diabetic ketoacidosis.
B
Supportive evidence from well-conducted cohort studies, including:
- Evidence from a well-conducted prospective cohort study or registry
- Evidence from a well-conducted meta-analysis of cohort studies
Supportive evidence from a well-conducted case-control study
C
Supportive evidence from poorly controlled or uncontrolled studies, including:
- Evidence from randomized clinical trials with one or more major or three or more minor methodological flaws that could invalidate the results
- Evidence from observational studies with high potential for bias (such as case series with comparison with historical controls)
- Evidence from case series or case reports
Conflicting evidence with the weight of evidence supporting the recommendation
E
Expert consensus or clinical experience
