Definition, Diagnostic Criteria, Screening, Diagnosis, and Classification of Diabetes and Categories of Glucose Intolerance

  • Lakshmana Perumal Nandhini
  • Sadishkumar Kamalanathan
  • Jayaprakash Sahoo


The diagnostic criteria for diabetes mellitus (DM) have undergone a sea change over the last several decades. The specific cutoff points for diagnosing DM still remain a matter of intense debate. Prediabetes is an intermediate state of hyperglycemia characterized by elevated plasma glucose levels above normal, though not qualifying for the diagnosis of DM. Recently, the glycosylated hemoglobin has been included as an additional parameter for the diagnosis of DM. The American Diabetes Association (ADA) 2017 guidelines have laid down certain risk factors for screening for diabetes and prediabetes. DM can be classified based on the underlying pathogenic mechanisms into the following categories: type 1 DM, type 2 DM, gestational diabetes mellitus (GDM), and secondary DM. Type 1 DM is characterized by complete cellular-mediated destruction of the β-cells resulting in insulinopenia and insulin replacement therapy for survival. In contrast to type 1 diabetes, type 2 DM is characterized by relative insulin deficiency due to β-cell dysfunction and resistance to the action of insulin in target tissues. GDM is defined as any degree of hyperglycemia that is first detected during pregnancy and encompasses true GDM and pre-existing DM. There is no one universal criteria for diagnosing GDM. Secondary diabetes group includes monogenic forms of diabetes and others with an underlying genetic defect affecting insulin secretion and action, diseases affecting the pancreas, diabetes associated with endocrine disorders, drug-induced diabetes, and post-transplantation diabetes.


Impaired glucose tolerance Gestational diabetes mellitus Monogenic diabetes Neonatal diabetes Prediabetes Secondary diabetes 



American Association of Clinical Chemistry


ATP-binding cassette, subfamily C, member 8


American College of Obstetricians and Gynecologists


American Diabetes Association


Cardiovascular disease


Diabetes Control and Complications Trial


Diabetes mellitus


Fibrocalculous pancreatic diabetes


Fasting plasma glucose


Glutamic acid decarboxylase


Glucose challenge test


Gestational diabetes mellitus


Glucose transporter


Hyperglycemia and pregnancy outcome


Hemoglobin A1c


Islet antigen 2


International Association of Diabetes and Pregnancy Study Groups


International Federation of Clinical Chemistry and Laboratory Medicine


Impaired fasting glucose


Impaired glucose tolerance


Potassium inwardly rectifying channel, subfamily J, member 11


Maturity-onset diabetes of the young


National Diabetes Data Group


National Glycohemoglobin Standardization Program


National Institute for Health and Care Excellence


New-onset diabetes after transplantation


Oral glucose tolerance test


Pancreatic ductal adenocarcinoma


Plasma glucose


Somatostatin agonists


United Kingdom Prospective Diabetes Study


World Health Organization


Zinc transporter 8



Diabetes mellitus

Diabetes is derived from its Greek root which means “to pass through,” and the word mellitus means “from honey.” Diabetes mellitus is defined by the World Health Organization as a metabolic syndrome characterized by chronic hyperglycemia resulting from any of the several conditions that cause defective insulin secretion and/or action.


It is a state characterized by metabolic abnormalities that increase the risk of developing diabetes mellitus and its complications.

Impaired glucose tolerance

Defined as an intermediate state where blood glucose levels are above normal but do not satisfy the criteria for diagnosing diabetes mellitus.

Gestational diabetes mellitus

Defined as any degree of glucose intolerance that was first detected during pregnancy regardless of whether the condition may have predated the pregnancy or persisted after the pregnancy.

Neonatal diabetes

Development of diabetes in the first 6 months of life.

NODAT (new-onset diabetes after transplantation)

Defined as occurrence of diabetes in previously nondiabetic persons after organ transplantation.


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Suggested Reading

  1. Edwards CM, Cusi K. Prediabetes: a worldwide epidemic. Endocrinol Metab Clin N Am. 2016;45(4):751–64. Scholar
  2. Hattersley AT, Patel KA. Precision diabetes: learning from monogenic diabetes. Diabetologia. 2017;60(5):769–77. Scholar
  3. Mack LR, Tomich PG. Gestational diabetes: diagnosis, classification, and clinical care. Obstet Gynecol Clin N Am. 2017;44(2):207–17. Scholar
  4. Mazziotti G, Formenti AM, Frara S, Maffezzoni F, Doga M, Giustina A. Diabetes in Cushing disease. Curr Diab Rep. 2017;17(5):32. Scholar
  5. Rickels MR, Bellin M, Toledo FG, Robertson RP, Andersen DK, Chari ST, Brand R, Frulloni L, Anderson MA, Whitcomb DC, PancreasFest Recommendation Conference Participants. Detection, evaluation and treatment of diabetes mellitus in chronic pancreatitis: recommendations from PancreasFest 2012. Pancreatology. 2013;13(4):336–42. Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Lakshmana Perumal Nandhini
    • 1
  • Sadishkumar Kamalanathan
    • 1
  • Jayaprakash Sahoo
    • 1
  1. 1.Department of EndocrinologyJIPMERPuducherryIndia

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