A patient has a 2-hour glucose tolerance test result of 140. What is the best recommendation for assessing her current risk of diabetes?

The best recommendation for assessing the patient’s current risk of diabetes is to perform a two-hour glucose tolerance test (GTT) at 6 weeks and every 3 years if the initial results are normal.

This approach is grounded in the need for careful monitoring and assessment over time, especially after an abnormal result like a two-hour GTT of 140, which is indicative of some level of glucose intolerance. By conducting a follow-up test at 6 weeks, you can reevaluate the patient's glucose tolerance and confirm whether the initial reading reflects a transient issue or a more chronic problem.

If the follow-up GTT returns to normal, conducting this assessment every three years allows for ongoing monitoring while minimizing unnecessary testing. This timeframe is consistent with current guidelines for diabetes screening, which recommend regular assessments based on individual risk factors and previous test results.

Annual fasting blood sugars, while useful, may not provide the same comprehensive assessment as the two-hour GTT, especially in contexts of screening for gestational diabetes or in those with a history of abnormal glucose tolerance. Regular annual testing might overlook potential fluctuations in glucose metabolism that occur outside a fasting state.

Immediate treatment with insulin is not warranted without clear evidence of diabetes that requires pharmacological intervention. An isolated two-hour GTT