Decision Pathway for Diabetes and Prediabetes

DECISION PATHWAY FOR DIABETES AND PREDIABETES

                   
   

Identify patients at high risk for developing diabetes2
Perform FPG, A1C, or 2‑hour 75 gram glucose challenge3

   
                 
 

Prediabetes1

• Help patient understand the seriousness of prediabetes

• Determine whether patient is ready to make changes

• Help patient identify action-oriented goals to achieve 5−10% weight loss, specify physical activity goals of ≥150min/week of moderate intensity, recommend reduced calories and reduced intake of calorie dense foods

• Screen for and treat modifiable CVD risk factors based on general guidelines for prevention and management of CVD

• Consider referral to a lifestyle intervention program based on the NIH‑sponsored Diabetes Prevention Program study

•  Consider use of metformin esp. in those who have been unable to lose ≥7% of their body weight, with BMI ≥35kg/m2, age <60yrs, and women with prior GDM

• Monitor at least annually for the development of type 2 diabetes

           

Diabetes

• Confirm diagnosis

• Initiate treatment

 
  100−125
mg/dL
Fasting
plasma
glucose
(FPG)4
≥126
mg/dL
 
   
       
 
   
  5.7−6.4% A1C ≥6.5%  
   
       
 
   
  140−199
mg/dL
2‑hour
75g oral
 glucose 
challenge
≥200
mg/dL
 
   
   
   
                 
NOTES

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: family history of diabetes or 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. 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.

REFERENCES

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. https://www.niddk.nih.gov/health-information/communication-programs/ndep/health-professionals/guiding-principles-care-people-risk-diabetes.

American Diabetes Association. Standards of medical care in diabetes—2019. Diabetes Care. 2019;42 Suppl 1:S13-S33.

(Rev. 12/2019)