2014糖尿病指南: 臨界糖尿病風險Risk Factors & Prediabetes

2014糖尿病指南: 臨界糖尿病風險Risk Factors & Prediabetes

Categories of Increased Risk for Diabetes (Prediabetes)

Impaired Fasting Glucose (IFG)
FPG 100 mg/dL-125 mg/dL (5.6 mmol/L-6.9 mmol/L)

OR

Impaired Glucose Tolerance (IGT)
2-hr PG in 75-g OGTT 140 mg/dL-199 mg/dL (7.8 mmol/L-11.0 mmol/L)

OR

A1C 5.7%-6.4%

For all tests
  - Risk is continuous, extending below lower limit of range and becoming disproportionately greater at higher ends of range
IFG and IGT
  - View as risk factors for diabetes and CVD

Criteria for Type 2 Diabetes, Prediabetes Testing in Asymptomatic Adults

Consider testing in all adults with BMI* ≥25 kg/m2 (overweight) and additional risk factors:
    • Physical inactivity
    • First-degree relative with diabetes
    • High-risk race/ethnicity
    • Women who delivered a baby >9 lb or were diagnosed with GDM
    • HDL-C <35 mg/dL ± TG >250 mg/dL
    • Hypertension (≥140/90 mm Hg or on therapy)
    • A1C ≥5.7%, IGT, or IFG on previous testing
    • Conditions associated with insulin resistance: severe obesity, acanthosis nigricans, PCOS
    • CVD history

If no risk factors: begin testing no later than age 45
*At-risk BMI may be lower in some ethnic groups

If normal results: repeat testing in ≥3-yr intervals
   • More frequent testing depending on initial test results, risk factors
   • Prediabetes: test yearly

Common Comorbidities Associated With Diabetes

   • Certain cancers (liver, pancreas, bladder, endometrium, breast, colon/rectum)*
   • Cognitive impairment
   • Depression
   • Dyslipidemia
   • Fatty liver disease
   • Fractures
   • Hearing impairment
   • Hypertension
   • Low testosterone (men)
   • Obesity
   • Obstructive sleep apnea
   • Periodontal disease

*Possibly only associated with type 2 diabetes

Source: American Diabetes Association.