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October 2010, Volume 40 Number 10 , p 54 - 56


  • Martha M. Funnell MS, RN, CDE


EACH YEAR, the American Diabetes Association (ADA) publishes standards of medical care for people with diabetes.1 The ADA updates these standards based on the latest evidence so that healthcare professionals can incorporate this evidence into their care. The standards also summarize and rate the levels of evidence on which the recommendations are based. This article describes new recommendations in the 2010 Standards of Medical Care in Diabetes (the 2010 Standards).In previous versions of the standards, the diagnoses of diabetes and prediabetes were made based on fasting plasma glucose (FPG) levels, or signs and symptoms of hyperglycemia and a casual (random) plasma glucose, or oral glucose tolerance test results. The 2010 Standards now also include the hemoglobin A1C (A1C) test for diagnosis, due in part to the increased standardization of the assay, which allows the results to be applied consistently across populations.2,3 A1C results represent an integrated measurement of hyperglycemia during a 2- to 3-month period and are more reproducible than glucose readings.An A1C level of 6.5% or higher has been added as one method for diagnosing diabetes.1 Point-of-care A1C testing isn't recommended for making the diagnosis. Plasma glucose levels of 126 mg/dL or higher when fasting (defined as no caloric intake for at least 8 hours), 200 mg/dL or higher 2 hours after a 75-g glucose load, or a random glucose of 200 mg/dL or higher with classic signs and symptoms of hyperglycemia (such as polyuria, polydipsia, or unexplained weight loss) continue to be diagnostic of diabetes.The A1C and plasma glucose levels used to diagnose diabetes were determined based on the presence of retinopathy at these thresholds.1–3 If clear signs and symptoms aren't present, the same diagnostic test should be repeated on a different day to confirm the diagnosis.Prediabetes is diagnosed when the FPG is 100 to 125 mg/dL or from 140 to 199 mg/dL 2 hours after a 75-g glucose load. Although

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