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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThis article discusses updated recommendations for the Standards of Medical Care for Diabetes [\u003Cem\u003EDiabetes Care\u003C\/em\u003E 2010] by the American Diabetes Association. These recommendations include revised screening guidelines; revised diagnostic criteria for intermediate hyperglycemia and diabetes, both of which include suggested glucose values during oral glucose tolerance test and for HbA1C; and guidance on which patients should be considered for treatment with metformin.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EHyperglycemia\/Hypoglycemia\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDiabetes Mellitus\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EThe American Diabetes Association (ADA) recently issued updated recommendations for the Standards of Medical Care for Diabetes [\u003Cem\u003EDiabetes Care\u003C\/em\u003E 2010]. These recommendations include revised screening guidelines; revised diagnostic criteria for intermediate hyperglycemia (IH) and diabetes, both of which include suggested glucose values during oral glucose tolerance test (OGTT) and for HbA1C; and guidance on which patients should be considered for treatment with metformin (ie, those with both impaired fasting glucose and impaired glucose tolerance, or those with HbA1C \u22656%).\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EThe new values for the diagnosis of diabetes are:\u003C\/p\u003E\u003Cul class=\u0022list-unord \u0022 id=\u0022list-1\u0022\u003E\u003Cli id=\u0022list-item-1\u0022\u003E\n            \u003Cp id=\u0022p-4\u0022\u003EHbA1C \u22656.5%, or\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-2\u0022\u003E\n            \u003Cp id=\u0022p-5\u0022\u003EFasting glucose \u2265126 mg\/dL (7.0 mmol\/L), or\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-3\u0022\u003E\n            \u003Cp id=\u0022p-6\u0022\u003E2-hour plasma glucose \u2265200 mg\/dL (11.1 mmol\/L) during an OGTT, or\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-4\u0022\u003E\n            \u003Cp id=\u0022p-7\u0022\u003ERandom plasma glucose \u2265200 mg\/dL (11.1 mmol\/L) in patients with classic symptoms of hyperglycemia or hyperglycemic crisis\u003C\/p\u003E\n         \u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-8\u0022\u003ETo diagnose individuals who are at high risk for diabetes, the values are:\u003C\/p\u003E\u003Cul class=\u0022list-unord \u0022 id=\u0022list-2\u0022\u003E\u003Cli id=\u0022list-item-5\u0022\u003E\n            \u003Cp id=\u0022p-9\u0022\u003EFasting plasma glucose 100\u2013125 mg\/dL (5.6\u20136.9 mmol\/L), or\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-6\u0022\u003E\n            \u003Cp id=\u0022p-10\u0022\u003E2-hour glucose 75 g OGTT 140\u2013200 mg\/dL (7.8\u201311.0 mmol\/L), or\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-7\u0022\u003E\n            \u003Cp id=\u0022p-11\u0022\u003EHbA1C between 5.7 and 6.4%\u003C\/p\u003E\n         \u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-12\u0022\u003EEmmaneul Cosson, MD, PhD, Paris-Nord University, Bondy, France, reported the results of a study that evaluated a diagnostic strategy using the new ADA OGTT and HbA1C criteria. The study included 1157 patients (962 women; body mass index 37.0 \u00b1 7.2 kg\/m\u003Csup\u003E2\u003C\/sup\u003E; mean age 41.2 \u00b1 13.5 years) who fulfilled the new ADA screening criteria but who had not been previously diagnosed with diabetes. All participants underwent an OGTT and measurement of HbA1C. Subjects were assessed for diabetes risk (using Findrisc and DESIR scores) and coronary risk (using UKPDS score).\u003C\/p\u003E\u003Cp id=\u0022p-13\u0022\u003EUse of the HbA1C strategy resulted in more patients being diagnosed with either IH (41%) or diabetes (10%) compared with the OGTT (27% and 6%, IH and diabetes, respectively; \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/10\/9\/36\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Patient Diagnosis: OGTT versus HbA1C.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-2123385994\u0022 data-figure-caption=\u0022Patient Diagnosis: OGTT versus HbA1C.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/10\/9\/36\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/10\/9\/36\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/10\/9\/36\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11562\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-14\u0022 class=\u0022first-child\u0022\u003EPatient Diagnosis: OGTT versus HbA1C.\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReproduced with permission from E. Cosson, MD, PhD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-15\u0022\u003EBased on the OGTT results, 11.2% of patients (n=130) would be eligible for treatment with metformin versus 22.0% (n=255) using the HbA1C strategy.\u003C\/p\u003E\u003Cp id=\u0022p-16\u0022\u003EThe sensitivity and specificity of HbA1C \u22656.5% for the diagnosis of diabetes according to the OGTT were 44.7% and 92.7%, respectively. In patients with HbA1C \u0026lt;6.5%, the sensitivity of HbA1C 5.7% to 6.4% for the diagnosis of IH was 57.9%, and the specificity was 59.3%. Diabetes risk score and UKPDS risk score were highest in patients with both an abnormal OGTT and HbA1C \u22655.7% (n=130).\u003C\/p\u003E\u003Cp id=\u0022p-17\u0022\u003EThe results of this study show that in a population that meets the new screening criteria, choosing the HbA1C strategy rather than the OGTT strategy leads to more individuals being diagnosed and more patients being treated with metformin, although the consistency of both diagnostic criteria is low (eg, 1\/3 of patients with HbA1C \u22656.5% have a normal OGTT). The patients who have the highest \u003Cem\u003Ea priori\u003C\/em\u003E risk of diabetes and cardiovascular disease are those with an abnormal OGTT that is associated with HbA1C \u22655.7%.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2010 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/10\/9\/36.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzmocp\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmocp\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}