Unifying Concepts

Criteria for Testing for Diabetes or Prediabetes in Asymptomatic Adults

“Prediabetes” is the term used for individuals with impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) and indicates an increased risk for the future development of diabetes. IFG and IGT should not be viewed as clinical entities in their own right but rather risk factors for diabetes and cardiovascular disease (CVD). IFG and IGT are associated with obesity (especially abdominal or visceral obesity), dyslipidemia with high triglycerides and/or low HDL cholesterol, and hypertension.

Criteria for testing for diabetes or prediabetes in asymptomatic adults
1. Testing should be considered in all adults who are overweight (BMI >/=25 kg/m2 or >/=23 kg/m2 in Asian Americans) and have additional risk factors:

  • Physical inactivity
  • First-degree relative with diabetes
  • High-risk race/ethnicity (e.g., African American, Latino, Native American, Asian American, Pacific Islander)
  • Women who delivered a baby weighing >9 lb (4000 g) or were diagnosed with gestational diabetes mellitus (GDM)
  • Hypertension (>/=140/90 mmHg or on therapy for hypertension)
  • HDL cholesterol level <35 mg/dL (0.90 mmol/L) and/or a triglyceride level >250 mg/dL (2.82 mmol/L)
  • Women with polycystic ovary syndrome
  • A1C >/=5.7% (39 mmol/mol), IGT, or IFG on previous testing
  • Other clinical conditions associated with insulin resistance (e.g., severe obesity, acanthosis nigricans)
  • History of CVD

2. Patients with prediabetes (A1C ≥5.7% [39 mmol/mol], IGT, or IFG) should be tested yearly.
3. Women who were diagnosed with Gestational Diabetes Mellitus (GDM) should have lifelong testing at least every 3 years.
4. For all other patients, testing should begin at age 45 years.
5. If results are normal, testing should be repeated at a minimum of 3-year intervals, with consideration of more frequent testing depending on initial results and risk status.
6. HIV



  1. American Diabetes Association. Classification and Diagnosis of Diabetes. Diabetes Care. 2016 Jan;39 Suppl 1:S13-22.  [Medline]
  2. Thomas CC, Philipson LH. Update on diabetes classification. Med Clin North Am. 2015 Jan;99(1):1-16. [Medline]
  3. American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2021. Diabetes Care. 2021 Jan;44(Suppl 1):S15-S33. [Medline]


Created Sep 02, 2016.
Update Feb 05, 2021.

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