Diabetes Criteria and Treatment Numbers

Criteria for Diagnosis of Diabetes*

1. A1C †† ≥ 6.5% or
2. Fasting plasma glucose > 126 mg/dl or
3. 2-hr plasma glucose > 200 mg/dl post 75g oral glucose challenge or
4. Random plasma glucose > 200 mg/dl with symptoms (polyuria, polydypsia, and unexplained weight loss)

_{*For criteria 1-3: Repeat test to confirm unless symptoms are present. It is preferable that the same test be repeated for confirmation. If two different tests are used (e.g., FPG and A1C) and both indicate diabetes, consider the diagnosis confirmed. If the two different tests are discordant, repeat the test above the diagnostic cut point.}

Criteria for Pre-diabetes**

1. Fasting plasma glucose 100 – 125 mg/dl [Impaired fasting glucose (IFG)] or
2. 2-hr post 75g oral glucose challenge 140 – 199 mg/dl [Impaired glucose tolerance (IGT)] or
3. A1C †† 5.7 % – 6.4 %

_{**For all tests, risk of diabetes is continuous, extending below the lower limit of the range and becoming disproportionately greater at higher ends of the range.}

Treatment Goals: the ABCs of Diabetes***

Main article: ABCs of Diabetes

A1C††

• < 7 % for people in general
• Preprandial capillary plasma glucose 70 – 130 mg/dl
• Peak postprandial capillary plasma glucose < 180 mg/dl (usually 1 to 2 hr after the start of a meal)

Blood pressure (mmHg)

• Systolic Diastolic
• < 130 / < 80

Cholesterol – Lipid Profile (mg/dl)

• LDL Cholesterol< 100
• HDL Cholesterol Men > 40, Women > 50
• Triglycerides< 150

Individualize target levels

For example, consider:

• A1C target as close to normal as possible without significant hypoglycemia in people with short duration of diabetes, little comorbidity, and long life expectancy.
• Less stringent A1C target for people with severe hypoglycemia, limited life expectancy, extensive comorbid conditions, advanced complications, or in longstanding diabetes where the general goal is difficult to attain despite optimal efforts.

See source materials for treatment recommendations.

† While utilizing American Diabetes Association Standards of Medical Care, Diabetes Care 33 (Suppl.1): S11-S61, 2010. NDEP recognizes that guidelines from other groups may vary reflecting the limitations and complexity of the evidence base.

†† A1C testing for diagnostic purposes should be performed in a laboratory using a method that is NGSP certified. Point of care A1C tests should not be used for diagnosis. Be alert to the impact of hemoglobin variants on A1C values. See www2.niddk.nih.gov/variants for information.