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Normoglycemia |
Pre-diabetes |
Diabetes* |
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Hemoglobin A1C <5.7 |
A1C between 5.7 - 6.4% |
A1C ≥6.5% |
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FPG <100 mg/dL |
FPG 100-125 mg/dL (Impaired Fasting Glucose = IFG) |
FPG ≥126 mg/dL |
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2 hr OGTT < 140 mg/dL |
2 hr OGTT 140-199 mg/dL (Impaired Glucose Tolerance = IGT) |
2 hr OGTT ≥ 200 mg/dL |
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Symptoms of diabetes and casual plasma glucose concentration ≥ 200 mg/dL |
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Diagnosis of diabetes must be confirmed on a subsequent day unless unequivocal symptoms of diabetes are present.
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FPG = Fasting Plasma Glucose (no caloric intake for 8 hours)
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OGTT = Oral Glucose Tolerance Test (75 gram glucose) |
Drug Therapy for Prediabetic Patients
There is increasing evidence that high risk patients may limit progression to type 2 diabetes using glitazones and metformin that target insulin resistance; however cost effectiveness has not yet been fully demonstrated.
For patients with IFG or IGT pre-diabetes, the ADA consensus panel currently recommends lifestyle modification including 5% to 10% weight loss and moderate intensity physical activity approximately 30 min/day.
The panel recommends lifestyle modification and metformin (850 mg twice per day) for individuals with IFG and IGT and any of the following:
- <60 years of age
- BMI ≥35 kg/m²
- family history of diabetes in first-degree relatives
- elevated triglycerides, reduced high density lipoprotein cholesterol
- hypertension
- A1C >6.0%.
If metformin is to be used, both IFG and IGT must be documented. Currently, the panel recommends that only metformin be considered as drug therapy for combined IFG and IGT based on effectiveness, safety, tolerability, and cost.
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