What are the ADA screening guidelines for glucose intolerance disorders?

Updated: Jun 28, 2019
  • Author: Samuel T Olatunbosun, MD, FACP, FACE; Chief Editor: George T Griffing, MD  more...
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Answer

Type 1 diabetes

The 2019 American Diabetes Association (ADA) guidelines notes that screening with an autoantibodies panel for type 1 diabetes risk is currently recommended only in the setting of a research trial or in first-degree relatives of a proband with type 1 diabetes. [4]

Type 2 diabetes

Equally appropriate tests for prediabetes and type 2 diabetes are fasting plasma glucose (FPG), 2-hour plasma glucose (PG) during a 75-g oral glucose tolerance test (GTT), and HBA1C. [4]

Consider risk-based screening for prediabetes and/or type 2 diabetes after the onset of puberty or after age 10 years (whichever occurs earlier) in overweight or obese children and adolescents (body mass index [BMI] ≥85th percentile or ≥95th percentile, respectively) and those with additional risk factors for diabetes. [4]

In asymptomatic adults, consider screening tests for prediabetes and type 2 diabetes mellitus with an informal assessment of risk factors or validate tools. [4] Consider screening tests for prediabetes and/or type 2 diabetes in asymptomatic adults of any age who are overweight or obese (BMI ≥25 kg/m2 (≥23 kg/m2 for Asian Americans) and have one or more additional risk factors, [4] including the following [1] :

  • Physical inactivity

  • First-degree relative with diabetes

  • High-risk ethnic background (eg, African American, Latino, Native American, Asian American, Pacific Islander)

  • Women who were diagnosed with gestational diabetes mellitus

  • Hypertension of 140/90 mm Hg and greater or on therapy for hypertension

  • High-density lipoprotein cholesterol (HDL-C) level below 35 mg/dL (0.90 mmol/L) and/or triglyceride level above 250 mg/dL (2.82 mmol/L)

  • Women with polycystic ovarian syndrome (PCOS) [66, 67, 68]

  • HBA1C ≥5.7% [39 mmol/mol], impaired glucose tolerance (IGT), or impaired fasting glucose (IFG) on previous testing

  • Other clinical conditions associated with insulin resistance (eg, severe obesityacanthosis nigricans)

  • History of cardiovascular disease

All individuals should be tested beginning at age 45 years. [4]  If test results are normal, it is reasonable to repeat testing at a minimum of 3-year intervals. Consider more testing more frequently depending on the initial results and risk status.

Test annually patients with prediabetes (HBAIC ≥5.7% [39 mmol/mol], IGT, or IFG). Women previously diagnosed with gestational diabetes should have lifelong testing at a minimum of every 3 years. [4]


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