American Diabetes Association releases New Standards Care & Screening

The American Diabetes Association just released their 2012 Standard of Care including screening recommendations for health care providers to use.

Here's a brief recap of just some of their diagnostic recommendations:

• Recommend use of the A1C to diagnose diabetes as the gold standard, but recommended including IFG.
• Defines impaired fasting glucose as (IFG - Fasting Plasma Glucose) levels 100 mg/dL [5.6 mmol/L] to 125 mg/dL [6.9 mmol/L]), or impaired glucose tolerance (IGT) (2-h values in the OGTT of 140 mg/dL [7.8 mmol/L] to 199 mg/dL [11.0 mmol/L]). 
• The A1C has several advantages to the FPG and OGTT, including greater convenience (since fasting is not required), evidence to suggest greater preanalytical stability, and less day-to-day perturbations during periods of stress and illness.
• Recommends diagnostic testing of diabetes should be repeated to rule out laboratory error; particularity when diagnosis is not clear.
• It is reasonable to consider an A1C range of 5.7 to 6.4% as identifying individuals with high risk for future diabetes, a state that may be referred to as prediabetes.
• Interventions should be most intensive and follow-up should be particularly vigilant for those with A1Cs >6.0%, who should be considered to be at very high risk

Here is a recap of some of their prevention and delay strategy recommendations:

• Patients with IGT (A), IFG (E), or an A1C of 5.7–6.4% (E) should be referred to an effective ongoing support program targeting weight loss of 7% of body weight and increasing physical activity to at least 150 min per week of moderate activity such as walking.
• Follow-up counseling appears to be important for success.
• Based on the cost-effectiveness of diabetes prevention, such programs should be covered by third-party payers.
• Metformin therapy for prevention of type 2 diabetes may be considered in those with IGT (A), IFG  or an A1C of 5.7–6.4% , especially for those with BMI >35 kg/m², age <60 years, and women with prior GDM. 
• At least annual monitoring for the development of diabetes in those with prediabetes is suggested.
  
  
  It's important to note the ADA calls out the effectiveness in lifestyle change programs: " intensive lifestyle modification programs that have been shown to be very effective". They go on to advise "Based on the results of clinical trials and the known risks of progression of prediabetes to diabetes, persons with an A1C of 5.7–6.4%, IGT, or IFG should be counseled on lifestyle changes with goals similar to those of the DPP (7% weight loss and moderate physical activity of at least 150 min per week)."
  
  
   You can read the entire report here:http://care.diabetesjournals.org/content/35/Supplement_1/S11.full#sec-171