Who should be tested
The American Diabetes Association recommends that blood glucose screening begin at age 45, or sooner if you have a body mass index above 25 and additional risk factors for prediabetes or type 2 diabetes. For example, if you:
- Are inactive
- Have a family history of type 2 diabetes
- Are African-American, Hispanic, American Indian, Asian-American or a Pacific Islander
- Have a history of gestational diabetes or have given birth to a baby who weighed more than 9 pounds (4.1 kilograms)
- Have a history of polycystic ovary syndrome
- Have high blood pressure
- Have abnormal cholesterol levels, including high-density lipoprotein (HDL) cholesterol levels below 35 mg/dL (0.9 mmol/L) or a triglyceride level above 250 mg/dL (2.83 mmol/L)
Tests used to diagnose prediabetes
Prediabetes testing may include the:
- Glycated hemoglobin (A1C) test. This blood test indicates your average blood sugar level for the past two to three months. It works by measuring the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells. The higher your blood sugar levels, the more hemoglobin you'll have with sugar attached. A normal A1C should be below 5.7 percent. An A1C level between 5.7 and 6.4 percent is considered prediabetes. A level of 6.5 percent or higher on two separate tests indicates you have diabetes.
Certain conditions can make the A1C test inaccurate — such as if you are pregnant or have an uncommon form of hemoglobin (known as a hemoglobin variant).
Following are other tests that your doctor may use to diagnose prediabetes:
Fasting blood sugar test. A blood sample will be taken after you fast for at least eight hours or overnight. Under these conditions, a blood sugar level lower than 100 milligrams per deciliter (mg/dL) — 5.6 millimoles per liter (mmol/L) — is normal.
A blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. This is sometimes referred to as impaired fasting glucose (IFG). A blood sugar level of 126 mg/dL (7.0 mmol/L) or higher may indicate diabetes mellitus.
Oral glucose tolerance test. This test is rarely used to diagnose diabetes except during pregnancy. A blood sample will be taken after you fast for at least eight hours or overnight. Then you'll drink a sugary solution, and your blood sugar level will be measured again after two hours. A blood sugar level less than 140 mg/dL (7.8 mmol/L) is normal.
A blood sugar level from 140 to 199 mg/dL (7.8 to 11.0 mmol/L) is considered prediabetes. This is sometimes referred to as impaired glucose tolerance (IGT). A blood sugar level of 200 mg/dL (11.1 mmol/L) or higher may indicate diabetes mellitus.
If your blood sugar level is normal, your doctor may recommend a screening test every three years. If you have prediabetes, further testing may be needed. For example, your doctor should check your fasting blood sugar, A1C, total cholesterol, HDL cholesterol, low-density lipoprotein (LDL) cholesterol and triglycerides at least once a year, possibly more frequently if you have additional risk factors for diabetes.
Dec. 17, 2014
- American Diabetes Association. Standards of medical care in diabetes — 2014. Diabetes Care. 2014;37(suppl):S14.
- Insulin resistance and pre-diabetes. National Institute of Diabetes and Digestive and Kidney Diseases. http://diabetes.niddk.nih.gov/dm/pubs/insulinresistance/. Accessed Nov. 24, 2014.
- Diabetes symptoms. American Diabetes Association. http://www.diabetes.org/diabetes-basics/symptoms/?loc=db-slabnav. Accessed Nov. 26, 2014.
- DeFronzo RA, et al. Preservation of beta-cell function: The key to diabetes prevention. Journal of Clinical Endocrinology and Metabolism. 2011; 96:2354.
- Senechal M, et al. Independent and combined effect of diet and exercise in adults with prediabetes. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy. 2014;7:521.
- McCulloch DK, et al. Prevention of type 2 diabetes mellitus. http://www.uptodate.com/home. Accessed Nov. 19, 2014.
- Natural medicines in the clinical management of diabetes. Natural Medicines Comprehensive Database. http://www.naturaldatabase.com. Accessed Nov. 26, 2014.
You Are ... The Campaign for Mayo Clinic
Mayo Clinic is a not-for-profit organization. Make a difference today.