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Clinical Context

Diabetes is one of the most common chronic conditions seen in practice. Yet for all of the patients known to have diabetes, many individuals with high serum glucose levels remain undiagnosed. With this in mind, the ADA has updated its recommendations for the diagnosis of type 2 diabetes, which include A1c level as a means to diagnose diabetes for the first time. Thus, the new diagnostic criteria for type 2 diabetes are as follows:

An A1c level of 6.5% or more.
Fasting plasma glucose level of 126 mg/dL or more.
A 2-hour plasma glucose level of 200 mg/dL or more after a 75-g oral glucose tolerance test.
A random plasma glucose level of 200 mg/dL or more in a patient with symptoms of hyperglycemia.
In the absence of symptoms of hyperglycemia, the first 3 options listed should be confirmed with repeated testing. The potential benefits of using A1c level in the initial diagnosis of type 2 diabetes include the ability to perform the test in a nonfasting state and less perturbation of the test result because of stress and illness. Patients with an A1c level between 5.7% and 6.4% should be considered to have prediabetes and should receive appropriate counseling on therapeutic lifestyle change.

Other recommendations from the ADA, particularly updates creating new guidelines, are summarized in the Study Highlights