Prediabetic is a person who meets following criteria
- Fasting plasma glucose between 100 and 125 mg/dL (5.6 to 6.9 mmol/L).
- Impaired glucose tolerance (IGT) Two-hour plasma glucose value during a 75 g oral lucose tolerance test between140 and 199 mg/dL (7.8 to 11.0 mmol/L)
- A1C Persons with 5.7 to 6.4 percen
What clinical risks ensue if prediabetes is not treated
- In the large DECODE Study, risks for all-cause mortality increased linearly as the 2-hour blood glucose level increased from 95 to 200 mg/dL.
- In the Diabetes Prevention Program, approximately 8% of patients with impaired glucose tolerance had diabetic retinopathy as did nearly 13% of those whose condition progressed to diabetes.
- The STOP NIDDM trial showed an increase in hypertension (> 140/90 mm Hg) in the placebo-treated patients with impaired glucose tolerance during a 3-year period, with an increase in clinical cardiovascular disease (CVD) events by approximately 5% during 4 years.
- The Honolulu Heart Study showed that postchallenge hyperglycemia was associated with an increase in sudden death during a 23-year follow-up
- Road Map to Prevent Type 2 Diabetes In Prediabetics
Ø Early Detection
All persons over the age of 30 and one of following conditions should undergo OGTT
- Family history of diabetes
- Cardiovascular disease
- Sedentary lifestyle
- Latino/Hispanic, African American, Asian American, Native American, or Pacific Islander
- Previously identified IGT or IFG
- Elevated triglycerides, low HDL, or both
- History of gestational diabetes
- Delivery of a baby weighing >9 lbs
- Severe psychiatric ill
Lifestyle Intervention in Prediabetes
- Persons with prediabetes should reduce weight by 5% to 10%, with long-term maintenance at this level
- A program of regular moderate-intensity physical activity for 30-60 minutes daily, at least 5 days a week, is recommended
- A diet that includes caloric restriction, increased fiber intake, and (in some cases) carbohydrate intake limitations is advised
For blood pressure control, lower sodium intake and avoidance of excess alcohol are recommended.
- For persons with prediabetes at particularly high risk, pharmacologic glycemic treatment may be considered in addition to lifestyle changes.
- Metformin and acarbose are safe and effective in helping prevent diabetes.
- Although thiazolidinediones decrease the risk for progression from prediabetes to diabetes, safety concerns include congestive heart failure or fractures
- Statins are recommended if needed to achieve treatment goals for low-density lipoprotein cholesterol levels (100 mg/dL), nonhigh-density lipoprotein cholesterol levels (130 mg/dL), and apolipoprotein B (90 mg/dL).
Patients with prediabetes should have the same target blood pressure as do persons with diabetes (systolic < 130 mg Hg; diastolic 80 mm Hg)