Mr. D.R. has an A1C of 6.7%, which is above the cutpoint for diabetes diagnosis, but a FPG of 6.3 mmol/L, which is in the category of prediabetes (IFG).
To be diagnosed with type 2 diabetes, a confirmatory test must be done on another day.
No, not yet.
Mr. D.R. has an A1C of 6.7%, which is above the cutpoint for diabetes diagnosis, but a FPG of 6.3 mmol/L, which is in the category of prediabetes (IFG).
To be diagnosed with type 2 diabetes, a confirmatory test must be done on another day.
2018 Diabetes Canada Diagnostic Criteria for Diabetes
FPG ≥ 7.0 mmol/L
Fasting = no caloric intake for at least 8 hours
or
A1C ≥ 6.5% (in adults)
Using a standardized, validated assay in the absence of factors that affect the accuracy of the A1C and not for suspected type 1 diabetes (see text)
or
2hPG in a 75-g OGTT ≥ 11.1 mmol/L
or
Random PG ≥ 11.1 mmol/L
Random = any time of the day, without regard to the interval since the last meal
In the absence of symptomatic hyperglycemia, if a single laboratory test result is in the diabetes range, a repeat confirmatory laboratory test (FPG, A1C, 2hPG in a 75 g OGTT) must be done on another day. It is preferable that the same test be repeated (in a timely fashion) for confirmation, but a random PG in the diabetes range in an asymptomatic individual should be confirmed with an alternate test. In the case of symptomatic hyperglycemia, the diagnosis has been made and a confirmatory test is not required before treatment is initiated. If results of 2 different tests are available and both are above the diagnostic thresholds, the diagnosis of diabetes is confirmed.
To avoid rapid metabolic deterioration in individuals in whom type 1 diabetes is likely (younger or lean or symptomatic hyperglycemia, especially with ketonuria or ketonemia), the initiation of treatment should not be delayed in order to complete confirmatory testing.
Because of discordance between the A1C (6.7%) and FPG (6.3 mmol/L), the test that is above the diagnostic cutpoint (A1C) should be repeated.
Repeat A1C is 6.6%
Diagnosis of type 2 diabetes is confirmed.
That answer is incorrect.
Because of discordance between the A1C (6.7%) and FPG (6.3 mmol/L), the test that is above the diagnostic cutpoint (A1C) should be repeated.
Repeat A1C is 6.6%
Diagnosis of type 2 diabetes is confirmed.
How to Handle Discordance:
If results of two different tests are available and both are above the diagnostic cut-points, the diagnosis of diabetes is confirmed. When results of more than one test are available (amongst FPG, A1C, 2hPG in a 75-g OGTT) and the results are discordant, the test whose result is above the diagnostic cut-point should be repeated, and the diagnosis is made on the basis of the repeat test.
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