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The page below is a sample from the LabCE course Diabetes: Diagnosis, Laboratory Testing, and the Current American Diabetes Association Guidelines (2018). Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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ADA Testing Guidelines for Type 2 Diabetes and Prediabetes in Asymptomatic Adults

Type 2 diabetes screening
Type 2 diabetes testing should be done in all asymptomatic adults who are overweight or obese (BMI ≥ 25 or ≥ 23 in Asian Americans) and who have one or more diabetes risk factors, including:
  • Physical inactivity
  • First-degree relative with diabetes
  • High-risk race/ethnic group
  • Women who delivered a baby > 9 pounds or were diagnosed with gestational diabetes (GDM)
  • High-density lipoprotein cholesterol (HDL-C) <35 mg/dL ± triglyceride (TG) >250 mg/dL
  • Hypertension (≥ 140/90 mm Hg or on therapy)
  • A1C ≥ 5.7%, impaired glucose tolerance (IGT) or impaired fasting glucose (IFG) on previous testing
  • Conditions associated with insulin resistance (eg, severe obesity, acanthosis nigricans, polycystic ovarian syndrome)
  • Cardiovascular disease (CVD) history
For all other patients, testing should begin at age 45 years. If results are normal, testing should be repeated at minimum of three-year intervals with more frequent testing depending on initial results and risk status.
Prediabetes screening
The ADA recommends that testing should begin at age 45 for all people. Testing for prediabetes and risk for future diabetes in asymptomatic people should be considered in adults of any age who are overweight and who have one or more additional risk factors for diabetes. Prediabetes testing can be done using Hgb A1C, FPG, or 2-h PG after 75-g OGTT.
In addition, the ADA recommends that prediabetes testing should be considered in children and adolescents who are overweight/obese and have two or more diabetes risk factors. .
Source: ADA Standards of Care, (2018), Available at: http://diabetesed.net/wp-content/uploads/2017/12/2018-ADA-Standards-of-Care.pdf. Accessed April 4, 2018.
Note: A more detailed discussion and review of laboratory test methods is presented in the section on Laboratory Assays in Evaluating Diabetic Patients.