Highlights
- Fasting Plasma Glucose and not HbA1C is the preferred diagnostic test for diabetes in children and non-pregnant adults.
- Screening for pre-diabetes and type 2 diabetes in asymptomatic people should be considered in adults with a BMI of 25 kg/m² or more and 1 or more other risk factors. Otherwise, testing should begin at age 45 years. If results are normal, testing should be repeated at intervals of 3 years or less.
- Fasting Plasma Glucose or 2-hour Oral Glucose Tolerance Test (OGTT) with 75-gm glucose load, or both, is appropriate to test for pre-diabetes or diabetes. OGTT may be considered in patients with impaired fasting glucose (IFG) levels to better define the risk for diabetes.
- Even those with pre-diabetes should be evaluated and treated for other cardiovascular risk factors.
- To prevent or delay onset of diabetes, patients with impaired glucose tolerance (IGT) or impaired fasting glucose should lose 5% to 10% of body weight and increase physical activity to 150 minutes per week or more of moderate activity.
- Metformin therapy should be considered in patients at very high risk for diabetes, based on combined IFG and IGT plus other risk factors, and who are obese and less than 60 years of age.
- Those with pre-diabetes should be monitored yearly for development of diabetes.
- Target HbA1C goal for non-pregnant adults is generally less than 7%, or less than 6% without significant hypoglycemia, for selected patients.
- Less stringent HbA1C goals may be appropriate in children and in those with a
- history of severe hypoglycemia,
- limited life expectancy,
- co-morbid conditions,
- long duration of diabetes and
- minimal or stable microvascular complications.
- Care should include
- management of energy balance,
- overweight and obesity with diet,
- physical activity and behavior modification;
- primary prevention of diabetes in high-risk patients;
- promoting fiber and whole-grain intake;
- controlling dietary fat intake by limiting saturated fat intake to less than 7% of total calories and minimizing trans fat intake; and managing carbohydrate intake.
- Monitoring carbohydrate intake is a key to glycaemic control, whether by carbohydrate counting, exchanges, or experience-based estimation.
- For patients with diabetes, glycaemic index and glycaemic load may improve glycaemic control vs that observed when considering only total carbohydrate intake.
- People with diabetes should perform 150 minutes per week or more of moderate-intensity aerobic physical activity (50% – 70% of maximum heart rate) and resistance training 3 times per week unless contraindicated.
- People with diabetes should be considered for employment based on job requirements, medical condition, treatment regimen, and medical history.
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