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Standards of Care

Standards of Care

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2013
2013

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Published by: 'Roberto 'Arteaga-Arias on Dec 30, 2012
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Evidence TableStandards of Medical Care in Diabetes--2013
2012Recommendations2013RecommendationsReason for Change New Evidence Citations from Review of 2011-2012,Reason for Inclusion, and Abstract of the paper
IntroductionCurrent criteria for the diagnosis of diabetesA1C
≥6.5%. The test should beperformed in a laboratory using amethod that is NationalGlycohemoglobin
Standardization Program (NGSP)-certified and standardized to the
Diabetes Control andComplications Trial (DCCT) assay
No changeReference 12Picon MJ, Murri M, Munoz A, Fernandez-Garcia JC,Gomez-
Huelgas R, Tinahones FJ: Hemoglobin a1cversus oral glucose tolerance test in postpartumdiabetes screening.
Diabetes Care
 
35:1648
-
1653,
2012in 2013 Standards of Care:
Reason for inclusion
Provides evidence to suggest that A1C +/-
FPG maynot be sensitive to diagnose type 2 DM in womenwith recent GDM.
 :
ABSTRACT
 
Determine usefulness of measuring A1C,alone or with the fasting glucose, compared withOGTT for reassessment of the carbohydratemetabolism status in postpartum women withhistory of GDM. RESEARCH DESIGN AND METHODS
 
2012Recommendations2013RecommendationsReason for Change New Evidence Citations from Review of 2011-2012,Reason for Inclusion, and Abstract of the paper
We evaluated the status of carbohydrate metabolismby performing OGTT and fasting glucose and A1Ctests in 231 postpartum women with prior GDM 1year after delivery. RESULTS The prevalence of abnormal carbohydrate metabolism was 45.89% byOGTT criterion, 19.05% by the A1C test criterion,38.10% by the fasting glucose test criterion, and46.75% by the A1C
-
fasting glucose criteria. UsingOGTT as gold standard, abnormal carbohydrate
me
tabolism according to the A1C test criterion had22.64% sensitivity and 54.55% positive predictivevalue; abnormal carbohydrate metabolism by thefasting glucose criterion had 83.02% sensitivity and100% positive predictive value. The A1C
-fasting
glucose test criteria classified 18
 
women with normalcarbohydrate metabolism as having abnormalcarbohydrate metabolism. Abnormal carbohydratemetabolism by the A1C
-
fasting glucose test criteriahad 83.02% sensitivity and 81.48% positive predictive
 
value. CONCLUSIONS Results indicate that A1Ccriterion alone or combined with fasting glucose
criterion does not provide sensitive and specific
diagnosis of abnormal carbohydrate metabolism inwomen who have had GDM.
 
OR fasting plasma glucose (FPG)≥126 mg/dl (7.0 mmol/l). Fastingis defined as no caloric intake forat least 8 h, or
 No Change
 
2012Recommendations2013RecommendationsReason for Change New Evidence Citations from Review of 2011-2012,Reason for Inclusion, and Abstract of the paper
OR 2-
h plasma glucose ≥200mg/dl (11.1 mmol/l) during anoral glucose tolerance test(OGTT). The test should beperformed as described by theWorld Health Organization, usin
g
a glucose load containing theequivalent of 75 g anhydrousglucose dissolved in water
No Change
OR in a patient with classicsymptoms of hyperglycemia orhyperglycemic crisis, a randomplasma glucose ≥200 mg/dl (11.1mmol/l)
 No ChangeIn the abs
ence of unequivocalhyperglycemia, result should beconfirmed by repeat testing.
 No Change
Testing for diabetes in asymptomatic patients
 
Testing to detect type 2 diabetesand assess risk for futurediabetes in asymptomatic peopleshould be considered
 
in adults of 
No change Reference 20in 2013 Standards of Care:
Erickson SC,Le L, Zakharyan A, Stockl KM, Harada AS, Borson S,Ramsey SD, Curtis B: New
-onset treatment-
dependent diabetes mellitus and hyperlipidemia

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