Testing should be considered in overweight or obese (BMI ≥25 kg/m2 or ≥23 kg/m2 in Asian Americans) adults who have one or more of the following risk factors:
A1C ≥5.7% (39 mmol/mol), impaired glucose tolerance, or impaired fasting glucose on previous testing
First-degree relative with diabetes
High-risk race/ethnicity (e.g., African American, Latino, Native American, Asian American, Pacific Islander)
Women who were diagnosed with GDM
History of CVD
Hypertension (≥140/90 mmHg or on therapy for hypertension)
HDL cholesterol level <35 mg/dL (0.90 mmol/L) and/or a triglyceride level >250 mg/dL (2.82 mmol/L)
Women with polycystic ovary syndrome
Other clinical conditions associated with insulin resistance (e.g., severe obesity, acanthosis nigricans)
For all patients, testing should begin at age 45 years.
If results are normal, testing should be repeated at a minimum of 3-year intervals, with consideration of more frequent testing depending on initial results (e.g., those with prediabetes should be tested yearly) and risk status.