Measures of Hyperglycemia Random plasma glucose RPGwithout regard

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Measures of Hyperglycemia Random plasma glucose (RPG)—without regard to time of last meal Fasting

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 1 c (A 1 C)—reflects mean glucose over 2– 3 months Fructosamine/glycated serum protein—reflects mean glucose over 1– 2 weeks 5

A 1 C Reflects Both Fasting and Postprandial Hyperglycemia Plasma glucose (mg/d. L) 300

A 1 C Reflects Both Fasting and Postprandial Hyperglycemia Plasma glucose (mg/d. L) 300 Postprandial hyperglycemia 200 Fasting hyperglycemia 100 Normal 0 0600 1200 1800 2400 0600 Time of day Riddle MC. Diabetes Care. 1990; 13: 676 -686 6

Rationale for Diagnostic Criteria Glycemic Thresholds for Retinopathy Values in Deciles for US Adults

Rationale for Diagnostic Criteria Glycemic Thresholds for Retinopathy Values in Deciles for US Adults Not Known to Have Diabetes NHANES III Prevalence of retinopathy (%) 15 FPG 2 -hour postprandial glucose (2 -h PPG) A 1 C 10 5 0 FPG (mg/d. L) 2 -h PPG (mg/d. L) A 1 C (%) <42 <34 <3. 3 <96 <102 <5. 4 American Diabetes Association. Diabetes Care. 2003; 26(suppl 1): S 5 -S 20 <109 120 <154 195 <5. 9 6. 2 7

Glucose Tolerance Categories FPG Plasma glucose (mg/d. L) 2 -h PPG (OGTT) 240 Diabetes

Glucose Tolerance Categories FPG Plasma glucose (mg/d. L) 2 -h PPG (OGTT) 240 Diabetes Mellitus 220 200 180 Diabetes Mellitus 160 140 126 120 IGT IFG Normal 100 80 Normal 60 American Diabetes Association. Diabetes Care. 2004; 27(suppl 1): S 5 -S 10 8

IFG and IGT Intermediate Between Normal and Diabetes Impaired Fasting Glucose (IFG) FPG 100

IFG and IGT Intermediate Between Normal and Diabetes Impaired Fasting Glucose (IFG) FPG 100 but 126 mg/d. L Predicts increased risk of diabetes and microand macrovascular complications Impaired Glucose Tolerance (IGT) 2 -h PG on OGTT 140 but 200 mg/d. L Predicts increased risk of diabetes and cardiovascula disease 9

Prevalence of Glycemic Abnormalities in the United States US Population: 275 Million in 2000

Prevalence of Glycemic Abnormalities in the United States US Population: 275 Million in 2000 Undiagnosed diabetes 5. 9 million Diagnosed type 1 diabetes ~1. 0 million Additional 24. 6 million with IGT Diagnosed type 2 diabetes 10 million Centers for Disease Control. Available at: http: //www. cdc. gov/diabetes/pubs/estimates. htm; Harris MI. In: National Diabetes Data Group. Diabetes in America. 2 nd ed. Bethesda, Md: 10