consider testing if person is: – overweight or obese with additional risk factor for diabetes –...
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Consider testing if person is:– Overweight or obese with additional risk factor for
diabetes– Age 45 or older
Obtain: A1C or FPG or 2-hour plasma glucose post 75g OGTT
Repeat testing every 3 years if results are normal
In patients with increased risk, identify and treat other CVD risk factors
American Diabetes Association. Diabetes Care 2010; 33;(Suppl1).
Objective: To determine if A1C is an optimal method for diagnosing diabetes and detecting pre-diabetes compared to IFG and IGT
Results:◦ Detection of pre-diabetes
IFG: 69.1% IGT: 59.5% A1C: 23.6%
Conclusion: A1C is less sensitive for detecting pre-diabetic individuals than IFG and IGT
Lorenzo et al. Diab Care. 2010 June 23. Epub ahead of print.
A1C Fasting Plasma Glucose Test
(FPG)
2-Hour Oral Glucose
Challenge
Acceptable ≤5.6% Below 100 mg/dl Below 140 mg/dl
Pre-Diabetes
5.7% - 6.4% 100-125 mg/dl (IFG)
140-199 mg/dl (IGT)
Diabetes ≥ 6.5% 126 mg/dl or above
200 mg/dl or above
American Diabetes Association. Diabetes Care 2010; 33;(Suppl.1):S11-61.
.
43% 37% 19% 14%16% 12%
*P<0.05; †P<0.0001.
Stratton IM, et al. BMJ. 2000;321(7258):405-412.
Lower-extremity
amputation or fatal
peripheral vascular disease†
Microvascular disease†
Cataract extraction†
Myocardial infarction†Heart
failure* Stroke*
Cardiovascular complications
*Multivariate regression – adjusted for age and risk factor; †Multivariate regression – adjusted for age, sex, and risk factor.EPIC-Norfolk: The European Prospective Investigation into Cancer in Norfolk was a prospective population study of 4,662 men and 5,570 women aged 45-79 years. Average follow-up time was 6.3 years.Khaw KT et al. Ann Intern Med. 2004;141:413-420.
1% Increase in A1C Above 5% 1% Increase in A1C Above 7%
CHD CVD TotalMortalit
y
0
10
20
30
4040%
16%
26%
Men
0
5
10
15
20
25
30
Total Mortalit
y
CHD CVD
21%24%25%
Total Mortalit
y
CHD CVD
Women
21%
28%
20%