The document provides diagnostic criteria and guidelines for impaired glucose metabolism according to the American Diabetes Association and World Health Organization. It discusses factors that can increase risk of type 2 diabetes such as age, weight, family history, and previous gestational diabetes. Hemoglobin A1c (HbA1c) is presented as a standard for assessing glycemic control and mean blood glucose as it represents glucose levels over the previous 2-3 months. Combining fasting plasma glucose and HbA1c levels is highly predictive of impaired glucose tolerance or diabetes. Higher HbA1c levels are associated with increased cardiovascular risk independent of other risk factors.

1. Diagnostic criteria for impair glucose metabolism

2. Diagnostic criteria for impair glucose metabolism Criteria ADA WHO Normoglycemia FPG< 100 mg/dl FPG< 110 mg/dl 2h PG< 140 mg/dl 2 hPG< 140 mg/dl IFG FPG≥ 100 and < 126 mg/dl FPG ≥ 110 and < 126 mg/dl IGT 2h PG ≥ 140 and < 200 mg/dl 2h PG ≥ 140 and < 200 mg/dl Diabetes FPG ≥ 126 mg/dl FPG ≥ 126 mg/dl 2h PG ≥ 200 mg/dl 2h PG ≥ 200 mg/dl Symtoms of DM and casual PG ≥ 200 mg/dl Note: To convert from the conventional unit to SI unit multiply by 0.0555

6. Correlation between mean blood glucose and HbA1c There is a linear relationship between HbA1c and mean plasma glucose (MPG) HbA1c (%) MPG (mg/dl) 6 120 7 150 8 180 9 210 10 240 11 270 Formular: MPG= (33.3 x HbA1c)-86

7. Glycemic goal for adult with DM Glycemic parameter ACE ADA HbA1c ≤ 6.5% < 7% FPG < 110 mg/dl 90-130 mg/dl postprandial glucose < 140 mg/dl < 180 In non-diabetes , increase HbA1c is associated with a significant increase risk of cardiovascular and cerebrovascular disease with hazard ratio of 1.13-1.7 at HbA1c ≥ 5.7%

10. EPIC-Norfolk all cause mortality relative risk AIC 5-5.4% 5.5-5.9 % 6-6.4 % 6.5-6.9 % >6.9 % Men RR 1.25 1.57 1.8 3.49 3.38 Death Women RR 1.02 1.28 1.61 1.71 6.91 Death