Fast Five Quiz: Glycemic Control in Type 2 Diabetes

Romesh Khardori, MD, PhD


February 21, 2023

Figure 1. Glycemia test before a meal. Here, the glucometer indicates that the person is in hyperglycemia.

According to the American Diabetes Association, an A1c level ≥ 6.5% (48 mmol/mol) meets the criteria for type 2 diabetes. Other criteria from the same association for the diagnosis of type 2 diabetes include:

  • Fasting plasma glucose level 126 mg/dL (7.0 mmol/L) or higher, where "fasting" is defined as no caloric intake for at least 8 hours, or

  • 2-hour plasma glucose level 200 mg/dL (11.1 mmol/L) or higher during an oral glucose tolerance test, which should be performed as described by the World Health Organization, using a glucose load containing the equivalent of 75 g anhydrous glucose dissolved in water, or

  • In a patient with classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma glucose level 200 mg/dL (11.1 mmol/L) or higher

Of note, in the absence of unequivocal hyperglycemia, a diagnosis of type 2 diabetes requires two abnormal test results from the same sample or preferably in two separate test samples.

The European Society of Cardiology Clinical Practice Guidelines on Diabetes, Pre-Diabetes, and Cardiovascular Diseases developed in collaboration with the European Association for the Study of Diabetes, recommend that the diagnosis of type 2 diabetes should be based on A1c and/or fasting plasma glucose. If it is still in doubt, an oral glucose tolerance test can be performed.

Learn more about the diagnosis of type 2 diabetes based on glycemic levels.


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