Decision Pathway for Diabetes and Prediabetes


Key: CVD = cardiovascular disease; GDM = gestational diabetes mellitus; NIH = National Institutes of Health

1 Prediabetes identifies an intermediate stage in the development of type 2 diabetes. It is important to intervene at this stage to prevent progression.

2 Consider testing in overweight/obese adults of any age with ≥1 of the following risk factors: first-degree relative with diabetes, history of CVD, high-risk race/ethnicity (eg, African American, Latino, Native American, Asian/Pacific Islander), hypertension, HDL <35mg/dL and/or TG >250mg/dL, polycystic ovary syndrome, physical inactivity, conditions associated with insulin resistance. Consider testing in women with overweight or obesity and/or who have one or more additional risk factors for diabetes who are planning a pregnancy. Test all women with prior GDM every 3yrs, and all other patients beginning at age 45yrs. In overweight/obese children or adolescents, and those with additional risk factors for diabetes, test after the onset of puberty or after 10yrs of age, whichever is earlier.

3 If tests are normal, repeat testing at a minimum of 3-yr intervals; more frequent testing depends on initial results and risk status.

4 Fasting is defined as no caloric intake for ≥8hrs.


Adapted from the National Diabetes Education Program: A program of the National Institutes of Health and the Centers for Disease Control and Prevention. Guiding principles for the care of people with or at risk for diabetes.

American Diabetes Association. Standards of medical care in diabetes—2020. Diabetes Care. 2020;43(Suppl. 1):S1–S212.

(Rev. 12/2020)