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

Version 4.0
Table S-1. Risk Factors for Type 2 Diabetes
VA/DoD Clinical Practice Guideline
for the Management of Diabetes Mellitus
RATIONALE
• Age ≥ 40 years
• Family history (First-degree relative with DM)
• Member of a high-risk population (e.g. African American, Hispanic American, Native American,
Asian American, and Pacific Islander)
• Prediabetes (i.e., history of impaired fasting glucose or impaired glucose tolerance tests) *
• Hypertension (blood pressure ≥140/90 mmHg)*
• High-density lipoprotein cholesterol (HDL-C) level ≤ 40 mg/dL (0.90 mmol/L) and triglyceride
(TG) level ≥ 250 mg/dL (2.82 mmol/L)*
• Presence of vascular disease (coronary, cerebrovascular or peripheral)*
• Overweight or Obesity (body mass index (BMI) ≥ 25 kg/m 2 )*
• Abdominal obesity*
• Women with polycystic ovarian syndrome (PCOS)*
• History of gestational diabetes mellitus (GDM)
• History of delivering babies weighing >9 pounds
• Other clinical conditions associated with insulin resistance (e.g. acanthosis nigricans, nonalcoholic
steatohepatitis (NASH))
• Schizophrenia
• Patients treated with certain atypical antipsychotics or antidepressants
• Habitual physical inactivity
* Associated with insulin resistance
The use of HbA 1 c for screening and diagnosis has been the subject of several consensus-based reports in the past
year. The VA-DoD Guidelines differ from these reports by recommending that an HbA 1 c test between 5.7% and
6.9% should be confirmed with a fasting blood glucose test for the purpose of diagnosis. This recommendation is
based upon the following factors: (1) Even using the National Glycohemoglobin Standardization Program (NGSP)
“gold standard” in a research setting, the HbA 1 c is higher in older individuals and non-Caucasians patients than
Caucasians for any traditional tests of glycemia. (2) In practice, even tests performed using clinical laboratory
methodologies standardized to the NSGP may not be accurate enough to distinguish an absolute 0.5% difference
between two HbA 1 c test results. High performance Liquid Chromatography (HPLC) methods tend to have a high
bias and the immunoassays tend to have a low bias. (3) Other co-morbid conditions such as, anemia, and chronic
kidney disease may impact HbA 1 c results. Thus, the positive and negative predictive value of HbA 1 c testing may
differ by methodology, age, race, and by comorbid conditions. Although an HbA 1 c test has a practical advantage
over FPG for screening given the fact that fasting is not necessary, reliance totally upon HbA 1 c testing for diagnosis
is tempered by the current lack of precision in practice.
While there is a continuous risk of developing diabetes that extends well into the normal range, i.e. a FPG below 100
mg/dl (or an HbA 1 c