However, other studies suggest A1C may not identify as many people as having diabetes compared to FPG or 2hPG (28).ĢhPG, 2-hour plasma glucose AlC, glycated hemoglobin FPG, fasting plasma glucose OGTT, oral glucose tolerance test PG, plasma glucose.įasting = no caloric intake for at least 8 hours In a Canadian context, A1C may identify more people as having diabetes than FPG (27). A1C testing also avoids the problem of day-to-day variability of glucose values as it reflects the average plasma glucose (PG) over the previous 2 to 3 months (1). A1C can be measured at any time of day and is more convenient than FPG or 2hPG in a 75 g OGTT. ![]() Although very specific, A1C is less sensitive to diagnose diabetes than traditional glucose criteria, there are, however, several advantages to using A1C for diabetes diagnosis (25,26). Although the diagnosis of diabetes is based on an A1C threshold for developing microvascular disease, A1C is also a continuous cardiovascular (CV) risk factor and a better predictor of CV events than FPG or 2hPG (23,24). The relationship between A1C and retinopathy is similar to that of FPG or 2hPG with a threshold at around 6.5% (2,16–22). A fasting plasma glucose (FPG) level of 7.0 mmol/L correlates most closely with a 2-hour plasma glucose (2hPG) value of ≥11.1 mmol/L in a 75 g oral glucose tolerance test (OGTT), and each predicts the development of retinopathy (15). These criteria are based on venous samples and laboratory methods (14). The diagnostic criteria for diabetes are summarized in Table 3 (1). Multigenerational, autosomal pattern of inheritance Noninsulin antihyperglycemic agents, gradual dependence on insulin may occur ∗ Neonatal diabetes is a form of diabetes with onset 25 but incidence increasing in adolescents, paralleling increasing rate of obesity in children and adolescents Clinical judgement with safe management and ongoing follow up is a prudent approach for all people diagnosed with diabetes, regardless of the type.Ĭlinical features distinguishing type 1 diabetes, type 2 diabetes and monogenic diabetes Genetic risk scoring for type 1 diabetes may provide marginal additional information over clinical features and autoantibodies, but it is too early to know its utility in clinical practice (13). Monogenic diabetes is a rare disorder caused by genetic defects of beta cell function that typically presents in young people (2 generations, onset 0.33 nmol/L (1 to 3 weeks after resolution of the DKA and 10 hours after the last dose of rapid- or intermediate-acting insulin or metformin, and 24 hours after the last dose of sulfonylurea or long-acting insulin) were often able to discontinue insulin, and be treated with noninsulin antihyperglycemic agents when blood glucose (BG) rose (12). Appendix 2 addresses the etiologic classification of diabetes, including less common forms associated with genetic mutations, diseases of the exocrine pancreas (such as cystic fibrosis), other diseases or drug exposure (such as glucocorticoids, medications to treat HIV/AIDS, and atypical antipsychotics). The classification of diabetes is summarized in Table 1. Gestational diabetes (GDM) refers to glucose intolerance with onset or first recognition during pregnancy. The majority of cases of diabetes can be broadly classified into 2 categories: type 1 diabetes and type 2 diabetes, although some cases are difficult to classify. There are several types of blood tests that can be done to determine if a person has diabetes and, in most cases, a confirmatory blood test is required to be sure. ![]() You should discuss the type of diabetes you have with your diabetes health-care team. Although not everyone with prediabetes will develop type 2 diabetes, many people will. Prediabetes refers to blood glucose levels that are higher than normal, but not yet high enough to be diagnosed as type 2 diabetes. Monogenic diabetes is a rare disorder caused by genetic defects of beta cell function. Gestational diabetes is a type of diabetes that is first recognized or begins during pregnancy. Type 2 diabetes occurs when the pancreas does not produce enough insulin or when the body does not effectively use the insulin that is produced. Type 1 diabetes occurs when the pancreas is unable to produce insulin. ![]() The term “prediabetes” refers to impaired fasting glucose, impaired glucose tolerance or an A1C of 6.0% to 6.4%, each of which places individuals at increased risk of developing diabetes and its complications. This permits the diagnosis of diabetes to be made on the basis of each of these parameters. The chronic hyperglycemia of diabetes is associated with significant long-term microvascular and cardiovascular complications.Ī fasting plasma glucose of ≥7.0 mmol/L, a 2-hour plasma glucose value in a 75 g oral glucose tolerance test of ≥11.1 mmol/L or a glycated hemoglobin (A1C) of ≥6.5% can predict the development of retinopathy.
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