Cited by 2,245Diabetes Management and ResearchDiabetes, Cardiovascular Risks, and LipoproteinsDiabetes and associated disorders

The DOI matches its Crossref record; 17 of the 17 references it cites were found in a registry or an index; none of the 37 sources its claims cite is checked for support yet.

Diagnosis and Classification of Diabetes Mellitus

Open access
American Diabetes Association·2013·Diabetes Care

Abstract

DIABETESMELLITUSdDiabetes is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both.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.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This ADA position statement reviews the definition, classification, and diagnostic criteria for diabetes and prediabetes, emphasizing type 1, type 2, other specific types, and gestational diabetes mellitus (GDM). It affirms glucose- and A1C-based diagnostic thresholds and recommends updated IADPSG criteria for GDM.

Key findings

  • Diabetes is classified into type 1 (5–10% of cases), type 2 (∼90–95%), other specific types, and GDM; immune-mediated type 1 diabetes shows one or more autoantibodies in 85–90% of individuals when fasting hyperglycemia is initially detected.
  • Diagnostic criteria include FPG ≥126 mg/dl (7.0 mmol/l), 2-h PG ≥200 mg/dl (11.1 mmol/l) during a 75-g OGTT, or A1C ≥6.5%; random plasma glucose ≥200 mg/dl (11.1 mmol/l) can diagnose diabetes in patients with classic hyperglycemic symptoms or hyperglycemic crisis.
  • Prediabetes/increased risk is defined as IFG 100–125 mg/dl (5.6–6.9 mmol/l), IGT 140–199 mg/dl (7.8–11.0 mmol/l), or A1C 5.7–6.4%; A1C 6.0–6.5% carries a 5-year diabetes risk of 25–50% and relative risk 20 times higher than A1C 5.0%.
  • GDM affects approximately 7% of pregnancies (range 1–14% depending on population and tests); IADPSG recommends a 75-g OGTT at 24–28 weeks, with GDM diagnosed if any value is exceeded: fasting ≥92 mg/dl (5.1 mmol/l), 1 h ≥180 mg/dl (10.0 mmol/l), or 2 h ≥153 mg/dl (8.5 mmol/l).

Methods

  • This is an ADA clinical/consensus statement that synthesizes prior Expert Committee reports, International Expert Committee recommendations, IADPSG guidance, and epidemiologic evidence to define diabetes classification and diagnostic thresholds.
  • Evidence cited includes cross-sectional retinopathy studies, NHANES analyses, the Diabetes Prevention Program, a systematic review of 44,203 individuals from 16 cohort studies with mean follow-up 5.6 years, and the HAPO study of ∼25,000 pregnant women.
  • Main analysis is narrative synthesis and expert consensus; no new primary data are reported.

Limitations

  • The paper states that few randomized clinical trial data exist for treating women newly diagnosed with GDM by only one abnormal glucose value, and that additional well-designed clinical studies are needed to determine optimal monitoring and treatment intensity.
  • The paper states A1C diagnostic limitations: greater cost, limited availability in some developing regions, incomplete correlation with average glucose in certain individuals, and misleading results in anemia and hemoglobinopathies; point-of-care A1C assays are not sufficiently accurate for diagnosis.
  • The text makes evident that this is a consensus/guideline document rather than a systematic review, and it notes imperfect concordance among FPG, 2-h PG, and A1C, with discordant results requiring repeat/confirmatory testing.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.2337/dc13-s067

Cites

17 of 17 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

0 of 37 cited sources checked · 0 supported · 0 flagged

  • Probably not a substantial claim. 52
  • It may state two separate claims as one. 36
75 of 75
  • The authors state this as an assumption.

    In insulin-resistant lipoatrophic diabetes, the lesion(s) must reside in the postreceptor signal transduction pathways.

    “Therefore, it is assumed that the lesion(s) must reside in the postreceptor signal transduction pathways.”
  • The paper relies on this without support.

    Structured lifestyle intervention aimed at increasing physical activity and producing 5–10% loss of body weight, and certain pharmacological agents, prevent or delay the development of diabetes in people with IGT.

    “Structured lifestyle intervention, aimed at increasing physical activity and producing 5–10% loss of body weight, and certain pharmacological agents have been demonstrated to prevent or delay the development of diabetes in people with IGT; the potential impact of such interventions to reduce mortality or the incidence of cardiovascular disease has not been demonstrated to date.”
  • The paper relies on this without support.

    A1C assays are now highly standardized so that their results can be uniformly applied both temporally and across populations.

    “However, A1C assays are now highly standardized so that their results can be uniformly applied both temporally and across populations.”
  • The paper relies on this without support.

    Point-of-care A1C assays are not sufficiently accurate at this time to use for diagnostic purposes.

    “Point-of-care A1C assays are not sufficiently accurate at this time to use for diagnostic purposes.”
  • The paper relies on this without support.

    The A1C can be misleading in patients with certain forms of anemia and hemoglobinopathies.

    “In addition, the A1C can be misleading in patients with certain forms of anemia and hemoglobinopathies, which may also have unique ethnic or geographic distributions.”
  • The paper relies on this without support.

    In practice, a large portion of the population with type 2 diabetes remains unaware of their condition.

    “However, in practice, a large portion of the population with type 2 diabetes remains unaware of their condition.”
  • The paper relies on this without support.

    GDM carries risks for the mother and neonate.

    “GDM carries risks for the mother and neonate.”
  • The paper relies on this without support.

    There are few data from randomized clinical trials regarding therapeutic interventions in women who will now be diagnosed with GDM based on only one blood glucose value above the specified cut points.

    “Admittedly, there are few data from randomized clinical trials regarding therapeutic interventions in women who will now be diagnosed with GDM based on only one blood glucose value above the specified cut points (in contrast to the older criteria that stipulated at least two abnormal values).”
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Metadata

Authors
American Diabetes Association
Corresponding author
American Diabetes Association
Venue
Diabetes Care
Published
2012-12-10
Volume
36
Issue
Supplement_1
Pages
S67-S74
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
OpenAlex
W4241151929
Cited by
2,245
References
16
Citations by year
2026: 56 · 2025: 122 · 2024: 180 · 2023: 235 · 2022: 250 · 2021: 191 · 2020: 180 · 2019: 132 · 2018: 108 · 2017: 121 · 2016: 150 · 2015: 198 · 2014: 212 · 2013: 99 · 2012: 6
FWCI
132.43
Type
journal article
Language
en
Open access
Licence
cc-by-nc-nd
Locations
  • Diabetes Care (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
Keywords
diabetes mellitus, diagnosis, classification, hyperglycemia, insulin secretion, insulin resistance, metabolic disorders, diabetes complications
MeSH terms
Diabetes Mellitus, Female, Humans, Male, Pregnancy

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