Measures of Hyperglycemia Random plasma glucose (RPG)—without regard to time of last meal Fasting plasma glucose (FPG)—before breakfast Oral glucose tolerance test (OGTT)—2 hours after a 75-g oral glucose drink Postprandial plasma glucose (PPG)—2 hours after a meal Hemoglobin A 1c (A1C)—reflects mean glucose over 2–3 months Fructosamine/glycated serum protein—reflects mean glucose over 1–2 weeks 5

Plasma glucose (mg/dL) Postprandial hyperglycemia Normal Fasting hyperglycemia Riddle MC. Diabetes Care. 1990;13: Time of day A1C Reflects Both Fasting and Postprandial Hyperglycemia 6

Rationale for Diagnostic Criteria Glycemic Thresholds for Retinopathy Values in Deciles for US Adults Not Known to Have Diabetes FPG 2-hour postprandial glucose (2-h PPG) A1C Prevalence of retinopathy (%) NHANES III FPG (mg/dL) 2-h PPG (mg/dL) A1C (%) American Diabetes Association. Diabetes Care. 2003;26(suppl 1):S5-S20 <42 <96 < <34 <102 < <3.3 <5.4 <

Glucose Tolerance Categories American Diabetes Association. Diabetes Care. 2004;27(suppl 1):S5-S10 FPG2-h PPG (OGTT) Plasma glucose (mg/dL) Normal Diabetes Mellitus Diabetes Mellitus Normal IGT IFG 8

IFG and IGT Intermediate Between Normal and Diabetes Impaired Glucose Tolerance (IGT) 2-h PG on OGTT  140 but  200 mg/dL Predicts increased risk of diabetes and cardiovascular disease Impaired Fasting Glucose (IFG) FPG  100 but  126 mg/dL Predicts increased risk of diabetes and micro- and macrovascular complications 9

Undiagnosed diabetes 5.9 million Prevalence of Glycemic Abnormalities in the United States Additional 24.6 million with IGT Diagnosed type 2 diabetes 10 million Diagnosed type 1 diabetes ~1.0 million Centers for Disease Control. Available at: Harris MI. In: National Diabetes Data Group. Diabetes in America. 2nd ed. Bethesda, Md: NIDDK; 1995:15-36; U.S. Census Bureau Statistical Abstract of the U.S.; 2001 US Population: 275 Million in