Decision Pathway for Diabetes and Prediabetes

DECISION PATHWAY FOR DIABETES AND PREDIABETES

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

Prediabetes*

• Help patient understand the seriousness of prediabetes

• Determine whether patient is ready to make changes

• Help patient identify action-oriented goals to achieve 5−7% weight loss through increased physical activity and healthier food choices

• Review LDL cholesterol, BP, aspirin use, and smoking status

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

• Consider use of metformin

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

*Prediabetes identifies an intermediate stage in the development of type 2 diabetes. It is important to intervene at this stage to prevent progression. Patients should be counseled on the need to lose weight by adopting a healthier lifestyle, including making healthy food choices and increasing physical activity. Consider referral to a lifestyle intervention program based on the principles of the National Institutes of Health-sponsored Diabetes Prevention Program such as the National Diabetes Prevention Program. Also consider metformin for patients under 60 years of age with prediabetes plus other risk factors, such as A1C>6%, hypertension, low HDL cholesterol, elevated triglycerides or family history of diabetes in a first-degree relative and who are obese (BMI of 30 or greater).

NIH = National Institutes of Health

REFERENCES

Adapted from the National Diabetes Education Program: A program of the National Institutes of Health and the Centers for Disease Control and Prevention. http://ndep.nih.gov/index.aspx.

American Diabetes Association. Standards of medical care in diabetes—2015. Diabetes Care. 2015;38 Suppl 1:S8−S16.

(Rev. 5/2018)