Building Competency in Diabetes Education THE ESSENTIALS

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Figure 5. Patient instructions for oral glucose tolerance test (10)

A1C is now recommended for diagnosis if a valid standardized assay is used, as well as taking several factors into consideration when using A1C as a screening tool (1). (See Chapter 7: Monitoring Glycemic Control, for further discussion of A1C.) • You should be on an unrestricted, high carbohydrate (≥60% total calories) diet and participate in unrestricted activity for at least three days before the test. • Fasting is required for at least eight hours prior to the test. The test is usually scheduled for the morning. • You should avoid smoking for at least one hour before the test. • You should relax for 30 minutes before the test begins. It is necessary to remain seated during the testing period. • Medications, such as diuretics, anti-hypertensive drugs, analgesic/anti-inflammatory drugs, steroids and nicotinic acids, can interfere with test results. Medications should be reviewed with your doctor before t ti i i iti t d Screening Discussing screening and risk factors is important for diabetes educators who often prepare and/or participate in awareness-raising initiatives with focus on prevention and early interventions. When engaging in discussion about screening, it is important to have a good understanding of the types of diabetes, risk factors, time to implement screening and tests to utilize.

Type 1 diabetes According to the 2018 Guidelines, screening for type 1 diabetes is not recommended since there is no evidence to intervene in preventing or delaying type 1 diabetes (42).

Type 2 diabetes The 2018 Guidelines continue to emphasize aggressive screening and early prevention for type 2 diabetes in adults (42), with the following recommendations: • All patients should be evaluated annually for type 2 diabetes risk on the basis of demographic and clinical criteria [Grade D, Consensus] .