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Table 2. WHO and ADA criteria for the diagnosis of diabetes

Criteria for the diagnosis of diabetes
Fasting plasma ≥126 mg/dl (7.0 mmol/l)
glucose (FPG)* (4, 5)
or
Post-prandial glucose ≥200 mg/dl (11.1 mmol/l)
(PPG) * (4, 5)
a
or
HbA 1c b * (5) ≥6.5%

or

Random plasma ≥200 mg/dl (11.1 mmol/l)
glucose c (5)

a Defined using the 2h oral glucose tolerance test (OGTT) after ingesting the 75g glucose load. 4
B The test should be performed in a laboratory using a method that is NGSP certified and stand-
ardised to the DCCT assay. 5
c In a patient with classic symptoms of hyperglycaemia or hyperglycaemic crisis. 5
* In the absence of unequivocal hyperglycaemia, FPG, PPG and HbA should be confirmed by
1c
repeat testing.

Glucose metabolism: an overview

T2DM is a disease of glucose homeostasis, so it is pertinent here to briefly
review the basics of glucose metabolism. ATP, the universal energy cur-
rency of life, is generated via the oxidation of glucose, non-esterified
fatty acids (NEFA) and, to a lesser extent, amino acids. Glucose can
be obtained from food via digestion or it can be synthesised in the
body. Glucose obtained from carbohydrates in the diet is actively
transported from the lumen of the intestine into the blood by the main
transporter protein, sodium-glucose transport protein 1 (SGLT-1) 9 10 The
majority of absorbed glucose reaches the liver where it is in part stored
as glycogen (glycogen synthesis), whilst the remainder is taken up by
peripheral tissues for both oxidative and non-oxidative (storage) use;
excess glucose is converted into lipids (de novo lipogenesis) in the liver
and, to a lesser degree, in adipose tissue. 11 12

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