Diagnosis and classification of diabetes mellitus

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

Patients with immune-mediated type 1 diabetes are prone to other autoimmune disorders such as Graves' disease, Hashimoto's thyroiditis, Addison's disease, vitiligo, celiac sprue, autoimmune hepatitis, myasthenia gravis, and pernicious anemia.

“These patients are also prone to other autoimmune disorders such as Graves' disease, Hashimoto's thyroiditis, Addison's disease, vitiligo, celiac sprue, autoimmune hepatitis, myasthenia gravis, and pernicious anemia.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

Patients with type 2 diabetes are at increased risk of developing macrovascular and microvascular complications.

“Nevertheless, such patients are at increased risk of developing macrovascular and microvascular complications.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

Type 2 diabetes is often associated with a strong genetic predisposition, more so than is the autoimmune form of type 1 diabetes.

“It is often associated with a strong genetic predisposition, more so than is the autoimmune form of type 1 diabetes.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Immune-mediated type 1 diabetes has strong HLA associations, with linkage to the DQA and DQB genes, and is influenced by the DRB genes.

“Also, the disease has strong HLA associations, with linkage to the DQA and DQB genes, and it is influenced by the DRB genes.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Type 2 diabetes accounts for ∼90-95% of those with diabetes.

“This form of diabetes, which accounts for ∼90–95% of those with diabetes, previously referred to as non–insulin-dependent diabetes, type 2 diabetes, or adult-onset diabetes, encompasses individuals who have insulin resistance and usually have relative (rather than absolute) insulin deficiency”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

One and usually more of the autoantibodies associated with immune-mediated type 1 diabetes are present in 85-90% of individuals when fasting hyperglycemia is initially detected.

“One and usually more of these autoantibodies are present in 85–90% of individuals when fasting hyperglycemia is initially detected.”

Probably not a substantial claim: may not pass S3 (load-bearing).

During the asymptomatic period of type 2 diabetes, an abnormality in carbohydrate metabolism can be demonstrated by measurement of plasma glucose in the fasting state or after an oral glucose load or by A1C.

“During this asymptomatic period, it is possible to demonstrate an abnormality in carbohydrate metabolism by measurement of plasma glucose in the fasting state or after a challenge with an oral glucose load or by A1C.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

Patients with diabetes have an increased incidence of atherosclerotic cardiovascular, peripheral arterial, and cerebrovascular disease.

“Patients with diabetes have an increased incidence of atherosclerotic cardiovascular, peripheral arterial, and cerebrovascular disease.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Immune-mediated type 1 diabetes accounts for only 5-10% of those with diabetes.

“This form of diabetes, which accounts for only 5–10% of those with diabetes, previously encompassed by the terms insulin-dependent diabetes or juvenile-onset diabetes, results from a cellular-mediated autoimmune destruction of the β-cells of the pancreas.”

Probably not a substantial claim: may not pass S3 (load-bearing).

MODY is characterized by impaired insulin secretion with minimal or no defects in insulin action.

“They are referred to as maturity-onset diabetes of the young (MODY) and are characterized by impaired insulin secretion with minimal or no defects in insulin action.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

Symptoms of marked hyperglycemia include polyuria, polydipsia, weight loss, sometimes polyphagia, and blurred vision.

“Symptoms of marked hyperglycemia include polyuria, polydipsia, weight loss, sometimes with polyphagia, and blurred vision.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The risk of developing type 2 diabetes increases with age, obesity, and lack of physical activity.

“The risk of developing this form of diabetes increases with age, obesity, and lack of physical activity.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The most common form of MODY is associated with mutations on chromosome 12 in a hepatic transcription factor referred to as hepatocyte nuclear factor (HNF)-1α.

“The most common form is associated with mutations on chromosome 12 in a hepatic transcription factor referred to as hepatocyte nuclear factor (HNF)-1α.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Acute, life-threatening consequences of uncontrolled diabetes are hyperglycemia with ketoacidosis or nonketotic hyperosmolar syndrome.

“Acute, life-threatening consequences of uncontrolled diabetes are hyperglycemia with ketoacidosis or the nonketotic hyperosmolar syndrome.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

Type 2 diabetes occurs more frequently in women with prior GDM and in individuals with hypertension or dyslipidemia.

“It occurs more frequently in women with prior GDM and in individuals with hypertension or dyslipidemia, and its frequency varies in different racial/ethnic subgroups.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

Long-term complications of diabetes include retinopathy with potential vision loss; nephropathy leading to renal failure; peripheral neuropathy with risk of foot ulcers, amputations, and Charcot joints; and autonomic neuropathy causing gastrointestinal, genitourinary, and cardiovascular symptoms and sexual dysfunction.

“Long-term complications of diabetes include retinopathy with potential loss of vision; nephropathy leading to renal failure; peripheral neuropathy with risk of foot ulcers, amputations, and Charcot joints; and autonomic neuropathy causing gastrointestinal, genitourinary, and cardiovascular symptoms and sexual dysfunction.”

Probably not a substantial claim: may not pass S3 (load-bearing).

MODY is inherited in an autosomal dominant pattern.

“They are inherited in an autosomal dominant pattern.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Some forms of type 1 diabetes have no known etiologies.

“Some forms of type 1 diabetes have no known etiologies.”

May combine two claims.

Idiopathic type 1 diabetes is strongly inherited, lacks immunological evidence for β-cell autoimmunity, and is not HLA associated.

“This form of diabetes is strongly inherited, lacks immunological evidence for β-cell autoimmunity, and is not HLA associated.”

May combine two claims.

Some patients with idiopathic type 1 diabetes have permanent insulinopenia and are prone to ketoacidosis, but have no evidence of autoimmunity.

“Some of these patients have permanent insulinopenia and are prone to ketoacidosis, but have no evidence of autoimmunity.”

Probably not a substantial claim: may not pass S3 (load-bearing).

In type 2 diabetes, a degree of hyperglycemia sufficient to cause pathologic and functional changes in target tissues, but without clinical symptoms, may be present for a long period before diabetes is detected.

“In the latter category, a degree of hyperglycemia sufficient to cause pathologic and functional changes in various target tissues, but without clinical symptoms, may be present for a long period of time before diabetes is detected.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

At least initially, and often throughout their lifetime, individuals with type 2 diabetes do not need insulin treatment to survive.

“At least initially, and often throughout their lifetime, these individuals do not need insulin treatment to survive.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

Chronic hyperglycemia of diabetes is associated with long-term damage, dysfunction, and failure of different organs, especially the eyes, kidneys, nerves, heart, and blood vessels.

“The chronic hyperglycemia of diabetes is associated with long-term damage, dysfunction, and failure of different organs, especially the eyes, kidneys, nerves, heart, and blood vessels.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

Most patients with type 2 diabetes are obese, and obesity itself causes some degree of insulin resistance.

“Most patients with this form of diabetes are obese, and obesity itself causes some degree of insulin resistance.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

Immune-mediated diabetes commonly occurs in childhood and adolescence, but it can occur at any age, even in the 8th and 9th decades of life.

“Immune-mediated diabetes commonly occurs in childhood and adolescence, but it can occur at any age, even in the 8th and 9th decades of life.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Individuals with extensive β-cell destruction and therefore no residual insulin secretion require insulin for survival.

“Individuals with extensive β-cell destruction and therefore no residual insulin secretion require insulin for survival.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Most cases of GDM resolve with delivery.

“Although most cases resolve with delivery, the definition applied whether or not the condition persisted after pregnancy and did not exclude the possibility that unrecognized glucose intolerance may have antedated or begun concomitantly with the pregnancy.”

May combine two claims.

Among the nondiabetic adult population, an FPG of 110 mg/dl (6.1 mmol/l) corresponds to an A1C of 5.6%, while an FPG of 100 mg/dl (5.6 mmol/l) corresponds to an A1C of 5.4%.

“linear regression analyses of these data indicate that among the nondiabetic adult population, an FPG of 110 mg/dl (6.1 mmol/l) corresponds to an A1C of 5.6%, while an FPG of 100 mg/dl (5.6 mmol/l) corresponds to an A1C of 5.4% (R.T. Ackerman, personal communication).”

• cites R.T. Ackerman, personal communicationNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

Certain viruses have been associated with β-cell destruction.

“Certain viruses have been associated with β-cell destruction.”

May combine two claims.

The diagnostic A1C cut point of 6.5% is associated with an inflection point for retinopathy prevalence, as are the diagnostic thresholds for FPG and 2-h PG.

“The diagnostic A1C cut point of 6.5% is associated with an inflection point for retinopathy prevalence, as are the diagnostic thresholds for FPG and 2-h PG (3).”

• cites [3] International Expert Committee, 2009, International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes, Diabetes Care sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

Patients receiving α-interferon have been reported to develop diabetes associated with islet cell antibodies and, in certain instances, severe insulin deficiency.

“Patients receiving α-interferon have been reported to develop diabetes associated with islet cell antibodies and, in certain instances, severe insulin deficiency.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Wolfram syndrome is an autosomal recessive disorder characterized by insulin-deficient diabetes and the absence of β-cells at autopsy.

“Wolfram syndrome is an autosomal recessive disorder characterized by insulin-deficient diabetes and the absence of β-cells at autopsy.”

May combine two claims.

If extensive enough, cystic fibrosis and hemochromatosis will damage β-cells and impair insulin secretion.

“If extensive enough, cystic fibrosis and hemochromatosis will also damage β-cells and impair insulin secretion.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Leprechaunism and Rabson-Mendenhall syndrome are two pediatric syndromes that have mutations in the insulin receptor gene with subsequent alterations in insulin receptor function and extreme insulin resistance.

“Leprechaunism and the Rabson-Mendenhall syndrome are two pediatric syndromes that have mutations in the insulin receptor gene with subsequent alterations in insulin receptor function and extreme insulin resistance.”

May combine two claims.

Production of mutant insulin molecules with resultant impaired receptor binding has been identified in a few families and is associated with an autosomal inheritance and only mildly impaired or even normal glucose metabolism.

“Similarly, the production of mutant insulin molecules with resultant impaired receptor binding has also been identified in a few families and is associated with an autosomal inheritance and only mildly impaired or even normal glucose metabolism.”

May combine two claims.

These studies demonstrated glycemic levels below which there was little prevalent retinopathy and above which the prevalence of retinopathy increased in an apparently linear fashion.

“These studies demonstrated glycemic levels below which there was little prevalent retinopathy and above which the prevalence of retinopathy increased in an apparently linear fashion.”

• cites [1] 1997, Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus, Diabetes Care sourceNot checked yet

  Not checked in the free run.

May combine two claims.

An A1C range of 6.0-6.5% had a 5-year risk of developing diabetes between 25 and 50% and relative risk 20 times higher compared with an A1C of 5.0%.

“An A1C range of 6.0--6.5% had a 5-year risk of developing diabetes between 25 and 50% and relative risk 20 times higher compared with an A1C of 5.0% (10).”

• cites [10] Zhang, 2010, A1C level and future risk of diabetes: a systematic review, Diabetes Care sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

Certain toxins such as Vacor and intravenous pentamidine can permanently destroy pancreatic β-cells.

“Certain toxins such as Vacor (a rat poison) and intravenous pentamidine can permanently destroy pancreatic β-cells.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Stiff-man syndrome is an autoimmune disorder of the central nervous system characterized by stiffness of the axial muscles with painful spasms; patients usually have high titers of GAD autoantibodies, and approximately one-third will develop diabetes.

“The stiff-man syndrome is an autoimmune disorder of the central nervous system characterized by stiffness of the axial muscles with painful spasms. Patients usually have high titers of the GAD autoantibodies, and approximately one-third will develop diabetes.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

Many genetic syndromes are accompanied by an increased incidence of diabetes, including the chromosomal abnormalities of Down syndrome, Klinefelter syndrome, and Turner syndrome.

“Many genetic syndromes are accompanied by an increased incidence of diabetes. These include the chromosomal abnormalities of Down syndrome, Klinefelter syndrome, and Turner syndrome.”

May combine two claims.

Many drugs can impair insulin secretion; these drugs may not cause diabetes by themselves, but they may precipitate diabetes in individuals with insulin resistance.

“Many drugs can impair insulin secretion. These drugs may not cause diabetes by themselves, but they may precipitate diabetes in individuals with insulin resistance.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Approximately 7% of all pregnancies (ranging from 1 to 14%, depending on the population studied and the diagnostic tests employed) are complicated by GDM, resulting in more than 200,000 cases annually.

“Approximately 7% of all pregnancies (ranging from 1 to 14%, depending on the population studied and the diagnostic tests employed) are complicated by GDM, resulting in more than 200,000 cases annually.”

May combine two claims.

Anti-insulin receptor antibodies can cause diabetes by binding to the insulin receptor, thereby blocking the binding of insulin to its receptor in target tissues; in some cases, these antibodies can act as an insulin agonist after binding to the receptor and can thereby cause hypoglycemia.

“Anti-insulin receptor antibodies can cause diabetes by binding to the insulin receptor, thereby blocking the binding of insulin to its receptor in target tissues. However, in some cases, these antibodies can act as an insulin agonist after binding to the receptor and can thereby cause hypoglycemia.”

May combine two claims.

Genetic abnormalities that result in the inability to convert proinsulin to insulin have been identified in a few families, and such traits are inherited in an autosomal dominant pattern; the resultant glucose intolerance is mild.

“Genetic abnormalities that result in the inability to convert proinsulin to insulin have been identified in a few families, and such traits are inherited in an autosomal dominant pattern. The resultant glucose intolerance is mild.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Point mutations in mitochondrial DNA have been found to be associated with diabetes and deafness.

“Point mutations in mitochondrial DNA have been found to be associated with diabetes and deafness”

Probably not a substantial claim: may not pass S3 (load-bearing).

The metabolic abnormalities associated with mutations of the insulin receptor may range from hyperinsulinemia and modest hyperglycemia to severe diabetes.

“The metabolic abnormalities associated with mutations of the insulin receptor may range from hyperinsulinemia and modest hyperglycemia to severe diabetes.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Diabetes occurs in patients with congenital rubella, although most of these patients have HLA and immune markers characteristic of type 1 diabetes.

“Diabetes occurs in patients with congenital rubella, although most of these patients have HLA and immune markers characteristic of type 1 diabetes.”

May combine two claims.

Diabetes caused by hormone excess generally occurs in individuals with preexisting defects in insulin secretion, and hyperglycemia typically resolves when the hormone excess is resolved.

“This generally occurs in individuals with preexisting defects in insulin secretion, and hyperglycemia typically resolves when the hormone excess is resolved.”

Probably not a substantial claim: may not pass S3 (load-bearing).

In type 1 diabetes, the cause is an absolute deficiency of insulin secretion.

“In one category, type 1 diabetes, the cause is an absolute deficiency of insulin secretion.”

May combine two claims.

Assigning a type of diabetes to an individual often depends on the circumstances present at the time of diagnosis, and many diabetic individuals do not easily fit into a single class.

“Assigning a type of diabetes to an individual often depends on the circumstances present at the time of diagnosis, and many diabetic individuals do not easily fit into a single class.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

The basis of abnormalities in carbohydrate, fat, and protein metabolism in diabetes is deficient action of insulin on target tissues.

“The basis of the abnormalities in carbohydrate, fat, and protein metabolism in diabetes is deficient action of insulin on target tissues.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Type 2 diabetes encompasses individuals who have insulin resistance and usually have relative (rather than absolute) insulin deficiency.

“This form of diabetes, which accounts for ∼90–95% of those with diabetes, previously referred to as non–insulin-dependent diabetes, type 2 diabetes, or adult-onset diabetes, encompasses individuals who have insulin resistance and usually have relative (rather than absolute) insulin deficiency”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

The vast majority of cases of diabetes fall into two broad etiopathogenetic categories.

“The vast majority of cases of diabetes fall into two broad etiopathogenetic categories (discussed in greater detail below).”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

Impairment of insulin secretion and defects in insulin action frequently coexist in the same patient, and it is often unclear which abnormality, if either alone, is the primary cause of hyperglycemia.

“Impairment of insulin secretion and defects in insulin action frequently coexist in the same patient, and it is often unclear which abnormality, if either alone, is the primary cause of the hyperglycemia.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Deficient insulin action results from inadequate insulin secretion and/or diminished tissue responses to insulin at one or more points in the pathways of hormone action.

“Deficient insulin action results from inadequate insulin secretion and/or diminished tissue responses to insulin at one or more points in the complex pathways of hormone action.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Several pathogenic processes are involved in the development of diabetes, ranging from autoimmune destruction of pancreatic β-cells with consequent insulin deficiency to abnormalities causing insulin resistance.

“Several pathogenic processes are involved in the development of diabetes. These range from autoimmune destruction of the β-cells of the pancreas with consequent insulin deficiency to abnormalities that result in resistance to insulin action.”

May combine two claims.

Insulin secretion is defective in patients with type 2 diabetes and insufficient to compensate for insulin resistance.

“Thus, insulin secretion is defective in these patients and insufficient to compensate for insulin resistance.”

Probably not a substantial claim: may not pass S3 (load-bearing).

In type 2 diabetes, the cause is a combination of resistance to insulin action and an inadequate compensatory insulin secretory response.

“In the other, much more prevalent category, type 2 diabetes, the cause is a combination of resistance to insulin action and an inadequate compensatory insulin secretory response.”

May combine two claims.

Several hormones (e.g., growth hormone, cortisol, glucagon, epinephrine) antagonize insulin action, and excess amounts of these hormones can cause diabetes.

“Several hormones (e.g., growth hormone, cortisol, glucagon, epinephrine) antagonize insulin action. Excess amounts of these hormones (e.g., acromegaly, Cushing's syndrome, glucagonoma, pheochromocytoma, respectively) can cause diabetes.”

Probably not a substantial claim: may not pass S3 (load-bearing).

For many years, GDM has been defined as any degree of glucose intolerance with onset or first recognition during pregnancy.

“For many years, GDM has been defined as any degree of glucose intolerance with onset or first recognition during pregnancy.”

Classified as probably not a substantial claim. May combine two claims.

The International Expert Committee recommended the use of the A1C test to diagnose diabetes, with a threshold of ≥6.5%, and ADA affirms this decision.

“In their recent report (3), an International Expert Committee, after an extensive review of both established and emerging epidemiological evidence, recommended the use of the A1C test to diagnose diabetes, with a threshold of ≥6.5%, and ADA affirms this decision.”

• cites [3] International Expert Committee, 2009, International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes, Diabetes Care sourceNot checked yet

  Not checked in the free run.

Classified as probably not a substantial claim.

A1C is a widely used marker of chronic glycemia, reflecting average blood glucose levels over a 2- to 3-month period of time.

“A1C is a widely used marker of chronic glycemia, reflecting average blood glucose levels over a 2- to 3-month period of time.”

Probably not a substantial claim: may not pass S4 (based).

The established glucose criteria for the diagnosis of diabetes remain valid, including FPG and 2-h PG.

“The established glucose criteria for the diagnosis of diabetes remain valid. These include the FPG and 2-h PG.”

Classified as probably not a substantial claim.

Prior Expert Committees have not recommended use of the A1C for diagnosis of diabetes, in part due to lack of standardization of the assay.

“Prior Expert Committees have not recommended use of the A1C for diagnosis of diabetes, in part due to lack of standardization of the assay.”

May combine two claims.

The A1C has several advantages to the FPG, including greater convenience, greater preanalytical stability, and less day-to-day perturbations during periods of stress and illness.

“Moreover, the A1C has several advantages to the FPG, including greater convenience, since fasting is not required, evidence to suggest greater preanalytical stability, and less day-to-day perturbations during periods of stress and illness.”

May combine two claims.

A1C correlates well with both microvascular and, to a lesser extent, macrovascular complications and is widely used as the standard biomarker for the adequacy of glycemic management.

“The test plays a critical role in the management of the patient with diabetes, since it correlates well with both microvascular and, to a lesser extent, macrovascular complications and is widely used as the standard biomarker for the adequacy of glycemic management.”

May combine two claims.

The 2003 ADA Expert Committee report reduced the lower FPG cut point to define IFG from 110 mg/dl (6.1 mmol/l) to 100 mg/dl (5.6 mmol/l), in part to ensure that prevalence of IFG was similar to that of IGT.

“It should be noted that the 2003 ADA Expert Committee report reduced the lower FPG cut point to define IFG from 110 mg/dl (6.1 mmol/l) to 100 mg/dl (5.6 mmol/l), in part to ensure that prevalence of IFG was similar to that of IGT.”

• cites [1] 1997, Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus, Diabetes Care sourceNot checked yet

  Not checked in the free run.

• cites [2] Genuth, 2003, Follow-up report on the diagnosis of diabetes mellitus, Diabetes Care sourceNot checked yet

  Not checked in the free run.

May combine two claims.

An A1C range of 5.7-6.4% identifies individuals with high risk for future diabetes, to whom the term prediabetes may be applied.

“Hence, it is reasonable to consider an A1C range of 5.7--6.4% as identifying individuals with high risk for future diabetes, to whom the term prediabetes may be applied.”

May combine two claims.

As A1C is used more commonly to diagnose diabetes in individuals with risk factors, it will also identify those at higher risk for developing diabetes in the future.

“As A1C is used more commonly to diagnose diabetes in individuals with risk factors, it will also identify those at higher risk for developing diabetes in the future.”

May combine two claims.

IFG and IGT are risk factors for diabetes as well as cardiovascular disease.

“IFG and IGT should not be viewed as clinical entities in their own right but rather risk factors for diabetes as well as cardiovascular disease.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

It is conceivable that the lower sensitivity of A1C at the designated cut point will be offset by the test's greater practicality, and that wider application of A1C may increase the number of diagnoses made.

“Thus, it is conceivable that the lower sensitivity of A1C at the designated cut point will be offset by the test's greater practicality, and that wider application of a more convenient test (A1C) may actually increase the number of diagnoses made.”

• AssumptionRests on an assumption: In practice, a large portion of the population with type 2 diabetes remains unaware of their condition.

Probably not a substantial claim: may not pass S4 (based).

The same test repeated for confirmation has a greater likelihood of concurrence.

“It is preferable that the same test be repeated for confirmation, since there will be a greater likelihood of concurrence in this case.”

May combine two claims.

The new GDM criteria will significantly increase the prevalence of GDM, primarily because only one abnormal value, not two, is sufficient to make the diagnosis.

“These new criteria will significantly increase the prevalence of GDM, primarily because only one abnormal value, not two, is sufficient to make the diagnosis.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

In most circumstances the nondiabetic test is likely to be in a range very close to the threshold that defines diabetes.

“Admittedly, in most circumstance the “nondiabetic” test is likely to be in a range very close to the threshold that defines diabetes.”

May combine two claims.

When a test above the diagnostic threshold is repeated, the second value is least likely to be below the cut point for A1C, somewhat more likely for FPG, and most likely for 2-h PG.

“This is least likely for A1C, somewhat more likely for FPG, and most likely for the 2-h PG.”