2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes—2022
Open accessAbstract
The American Diabetes Association (ADA) “Standards of Medical Care in Diabetes” includes the ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc22-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA’s clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc22-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Glycemic management is primarily assessed with the HbA1c test, which was the measure used in trials demonstrating the benefits of glucose lowering.
“Glycemic management is primarily assessed with the HbA1c test, which was the measure used in trials demonstrating the bene fi ts of glucose lowering (2,52).”
From Management of Hyperglycemia in Type 2 Diabetes, 2022. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) (2022) · cites this paper as [52]
The Fasting and 2-Hour Plasma Glucose section (page unavailable) describes A1C as a measure of average blood glucose and says point-of-care A1C may be used to assess glycemic control in the clinic. It does not establish that HbA1c is the primary measure of glycemic management or say it was the measure used in trials demonstrating benefits of glucose lowering. (LLM, conf=0.83)
Experimental — accuracy not yet measuredAutoantibody markers are usually present in 85% to 90% of individuals with type 1 diabetes when fasting hyperglycemia is initially detected.
“Autoantibody markers are usually present in 85% to 90% of individuals with type 1 diabetes when fasting hyperglycemia is initially detected (2).”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [2]
The Diagnosis section says that stage 1 type 1 diabetes is defined by two or more autoimmune markers, supporting their role in the disease. Our copy does not give an 85%–90% prevalence or tie that figure to the initial detection of fasting hyperglycemia; searches for those terms found no matching passage. Page numbers were not provided. (LLM, conf=0.82)
Experimental — accuracy not yet measuredChronic diseases, such as T2DM, develop over a long period.
“Chronic diseases, such as T2DM, develop over a long period [102].”
From Digital Health Interventions to Prevent Type 2 Diabetes Mellitus: Systematic Review (2025) · cites this paper as [102]
The Type 2 Diabetes section says hyperglycemia develops gradually and type 2 diabetes frequently goes undiagnosed for many years, supporting the claim about T2DM. The paper does not establish that chronic diseases generally develop over a long period. (LLM, conf=0.82)
Experimental — accuracy not yet measured10 of 42 (24%) men with fibromyalgia syndrome had a 2-hour plasma glucose level ≥140 mg/dL on the oral glucose tolerance test, indicative of impaired glucose tolerance.
“Overall, 10 of 42 (24%) patients had a 2-hour plasma glucose level ≥140 mg/dL on the oral glucose tolerance test indicative of impaired glucose tolerance according to the World Health Organization (WHO) and the American Diabetes Association.1”
From Pain and small fiber pathology in men with fibromyalgia syndrome (2024) · cites this paper as [1]
The Diagnosis section defines impaired glucose tolerance as a 2-hour plasma glucose level of 140–199 mg/dL during a 75-g oral glucose tolerance test. The cited standard supports the 140 mg/dL lower threshold, but not the unqualified claim that every result ≥140 mg/dL indicates impaired glucose tolerance; the paper gives 200 mg/dL as the diagnostic threshold for diabetes. The count of 10 of 42 patients is the citing authors’ result, not a finding attributed to this guideline. (LLM, conf=0.86)
Experimental — accuracy not yet measuredHbA1c measurement has limitations.
“As with any laboratory test, HbA1c measurement has limitations (2,52).”
An HbA1c value of 6.5% (48 mmol/mol) or greater is considered diagnostic of diabetes.
“An HbA 1c value of 6.5% (48 mmol/mol) or greater is considered diagnostic.”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [2]
Depending on the specific MODY mutation, the disease can be mild (e.g., glucokinase mutation) and not usually associated with long term complications of diabetes or as severe as typical type 1 diabetes (e.g., HNF mutations).
“Depending on the specific MODY mutation, the disease can be mild (e.g., glucokinase mutation) and not usually associated with long term complications of diabetes or as severe as typical type 1 diabetes (e.g., hepatocyte nuclear factor [HNF] mutations) (2).”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [2]
ABCC8-related neonatal diabetes is responsive to sulfonylureas.
“responsive to sulfonylureas”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [2]
HNF1B-MODY is characterized by genitourinary abnormalities.
“genitourinary”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [2]
KCNJ11-related neonatal diabetes may have developmental delay and seizures.
“developmental delay and seizures”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [2]
KCNJ11-related neonatal diabetes is responsive to sulfonylureas.
“responsive to sulfonylureas”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [2]
KCNJ11 mutations cause permanent or transient neonatal diabetes.
“Permanent or transient: IUGR”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [2]
HNF1B-MODY is characterized by gout.
“gout”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [2]
KCNJ11-related neonatal diabetes is characterized by intrauterine growth restriction (IUGR).
“IUGR”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [2]
HNF1B mutations are inherited in an autosomal dominant manner.
“HNF1B | AD”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [2]
ABCC8 mutations cause permanent or transient neonatal diabetes.
“Permanent or transient: IUGR”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [2]
HNF1B mutations cause HNF1B-MODY.
“HNF1B-MODY”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [2]
HNF1B-MODY is characterized by atrophy of the pancreas.
“atrophy of the pancreas”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [2]
HNF1B-MODY is characterized by developmental renal disease, typically cystic.
“HNF1B-MODY: developmental renal disease”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [2]
KCNJ11 mutations are inherited in an autosomal dominant manner.
“KCNJ11 | AD”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [2]
ABCC8-related neonatal diabetes rarely has developmental delay.
“developmental delay”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [2]
ABCC8 mutations are inherited in an autosomal dominant manner.
“ABCC8 | AD”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [2]
INS-related neonatal diabetes is insulin requiring.
“insulin requiring”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [2]
INS-related neonatal diabetes is characterized by intrauterine growth restriction (IUGR).
“IUGR”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [2]
ABCC8-related neonatal diabetes is characterized by intrauterine growth restriction (IUGR).
“IUGR”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [2]
INS mutations cause permanent neonatal diabetes.
“Permanent: IUGR; insulin requiring”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [2]
HNF1B-MODY is characterized by hyperuricemia.
“hyperuricemia”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [2]
INS mutations are inherited in an autosomal dominant manner.
“INS | AD”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [2]
6q24-related transient neonatal diabetes may be treatable with medications other than insulin.
“medications other than insulin”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [2]
GATA6-related neonatal diabetes is insulin requiring.
“insulin requiring”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [2]
GATA6 mutations are inherited in an autosomal dominant manner.
“GATA6 | AD”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [2]
EIF2B1 mutations are inherited in an autosomal dominant manner.
“EIF2B1 | AD”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [2]
Wolcott-Rallison syndrome is characterized by epiphyseal dysplasia.
“epiphyseal dysplasia”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [2]
6q24-related transient neonatal diabetes mechanisms include UPD6, paternal duplication, or maternal methylation defect.
“mechanisms include UPD6”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [2]
6q24-related transient neonatal diabetes is characterized by macroglossia.
“macroglossia”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [2]
EIF2AK3 mutations are inherited in an autosomal recessive manner.
“EIF2AK3 | AR”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [2]
GATA6-related neonatal diabetes is characterized by pancreatic exocrine insufficiency.
“pancreatic exocrine”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [2]
EIF2B1-related permanent diabetes can be associated with fluctuating liver function.
“fluctuating liver function”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [2]
GATA6-related neonatal diabetes is characterized by pancreatic hypoplasia.
“pancreatic hypoplasia”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [2]
EIF2B1 mutations cause permanent diabetes.
“Permanent diabetes”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [2]
GATA6-related neonatal diabetes is characterized by cardiac malformations.
“cardiac”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [2]
Wolcott-Rallison syndrome is characterized by pancreatic exocrine insufficiency.
“pancreatic exocrine”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [2]
GATA6 mutations cause permanent neonatal diabetes.
“Permanent: pancreatic hypoplasia; cardiac”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [2]
IPEX syndrome is characterized by immunodysregulation, polyendocrinopathy, and enteropathy.
“immunodysregulation”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [2]
IPEX syndrome is characterized by autoimmune diabetes.
“autoimmune diabetes”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [2]
Wolcott-Rallison syndrome is insulin requiring.
“insulin requiring”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [2]
EIF2AK3 mutations cause permanent neonatal diabetes (Wolcott-Rallison syndrome).
“Permanent: Wolcott-Rallison syndrome”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [2]
6q24 (PLAGL1, HYMA1) paternal duplications are inherited in an autosomal dominant manner.
“6q24 (PLAGL1, HYMA1) | AD for paternal duplications”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [2]
6q24-related transient neonatal diabetes is characterized by intrauterine growth restriction (IUGR).
“IUGR”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [2]
FOXP3 mutations are X-linked.
“FOXP3 | X-linked”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [2]
6q24 (PLAGL1, HYMA1) paternal duplications cause transient neonatal diabetes.
“Transient: IUGR; macroglossia; umbilical”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [2]
FOXP3 mutations cause permanent neonatal diabetes (IPEX syndrome).
“Permanent: immunodysregulation,”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [2]
6q24-related transient neonatal diabetes is characterized by umbilical hernia.
“hernia”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [2]
IPEX syndrome is insulin requiring.
“insulin requiring”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [2]
IPEX syndrome is characterized by exfoliative dermatitis.
“exfoliative”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [2]
IPEX syndrome is characterized by autoimmune thyroid disease.
“autoimmune thyroid disease”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [2]
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BackgroundDiagnosis and Classification of Diabetes Mellitus
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ACOG Practice Bulletin No. 190: Gestational Diabetes Mellitus
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Glucose-6-phosphate dehydrogenase deficiency
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“4-fold higher risk of developing prediabetes and type 2 diabetes and had children with a higher risk of obesity and increased body fat, suggesting that the larger group of women identified by the one-step approach would benefit from the increased screening for diabetes and prediabetes that would accompany a history of…”
BackgroundCollateral damage: Insulin-dependent diabetes induced with checkpoint inhibitors
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Diabetic emergencies - ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia
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“No studies to date have established which noninsulin agents are safest or most efficacious in PTDM.”
BackgroundMethodInfluentialDiabetes, pancreatogenic diabetes, and pancreatic cancer
Andersen, D. K., Korc, M., Petersen, G. M., Eibl, G., Li, D., Rickels, M. R., Chari, S. T., & Abbruzzese, J. L. (2017) · Diabetes · doi:10.2337/db16-1477 · Cited by 516 · see citing works
BMI Cut Points to Identify At-Risk Asian Americans for Type 2 Diabetes Screening
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- Authors
- American Diabetes Association Professional Practice Committee
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2021-12-16
- Volume
- 45
- Issue
- Supplement_1
- Pages
- S17-S38
- ISSN
- 0149-5992 (ISSN-L)
- OpenAlex
- W4200148796
- Semantic Scholar
- a1d863e5f4d381bf99eea7ee26e18dcc69f81a15
- Cited by
- 4,792
- References
- 253
- Citations by year
- 2026: 293 · 2025: 689 · 2024: 1026 · 2023: 1164 · 2022: 814 · 2021: 356 · 2020: 238 · 2019: 145 · 2018: 53 · 2017: 3 · 2016: 1 · 2015: 3 · 2013: 1
- FWCI
- 129.37
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- diabetes classification, diabetes diagnosis, diabetes diagnosis criteria, diabetes subtypes
- MeSH terms
- Diabetes Mellitus, Endocrinology, Humans, Reference Standards, Societies, Medical, Standard of Care
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