DM Full Guideline (2010) - VA/DoD Clinical Practice Guidelines Home

Version 4.0
MODULE D – CORE
ANNOTATIONS
VA/DoD Clinical Practice Guideline
for the Management of Diabetes Mellitus
The core module provides an overview of the important components of diabetes care that should be considered at
each visit and the interventions that should be performed at appropriate intervals. This module will assist the
provider to organize and prioritize a care plan for persons with diabetes mellitus (DM).
A. Patient with Diabetes Mellitus
Diabetes mellitus (DM) is a state of absolute or relative insulin deficiency resulting in hyperglycemia. This
algorithm applies to adults only (age ≥17), both diabetes type 1 and type 2 (formerly referred to as insulin-dependent
and non-insulin dependent diabetes mellitus), but not to gestational diabetes mellitus (GDM).
Diagnosis of Diabetes
The criteria for the diagnosis of DM include any of the following:
a. Fasting plasma glucose (FPG) is ≥126 mg/dL on at least two occasions; or,
b. A single HbA 1 c reading of ≥ 6.5% confirmed with a FPG ≥126 mg/dL. These tests can be done
on the same or different days; or,
c. HbA 1 c reading of ≥ 7% on two occasions using a clinical laboratory methodology standardized to
the National Glycohemoglobin Standardization Program (NGSP) not a Point of Care; or ,
d. Patient with symptoms of hyperglycemia, and a random glucose is ≥ 200 mg/dL on two
occasions. However, random plasma glucose is not recommended as a routine screening test.
Oral glucose tolerance testing (OGTT) is no longer recommended in clinical practice. An individual with a casual
plasma glucose level ≥200 mg/dL, but without symptoms, should have his or her fasting blood glucose measured.
The diagnostic criteria for diabetes are summarized in table D1. (See Module S: Screening for DM)
Diagnosis of Prediabetes
Hyperglycemia not sufficient to meet the diagnostic criteria for diabetes has historically been categorized as
either impaired fasting glucose (IFG), or impaired glucose tolerance (IGT) depending on the methodology
through which it is identified.
The criteria for diagnosis of prediabetes include any of the following:
a. Fasting plasma glucose (FPG) readings with result < 126 mg/dL, but ≥100mg/dL on two
occasions.
b. HbA 1 c readings with result ≥5.7%, with FPG ≥100 mg/dL and