Managing Prediabetes Before It Becomes Unmanageable

Saturday, October 19 at 1:55 pm

LAS VEGAS—Up to 70% of individuals with prediabetes will eventually develop diabetes, according to an American Diabetes Association expert panel. In fact, estimates suggest that 5% to 10% of people with prediabetes progress to diabetes each year. By identifying and managing prediabetes, there are tremendous opportunities to minimize morbidity and mortality among these patients.

Steven Milligan, MD, FAAFP, DABFP, of Southern Colorado Family Medicine in Pueblo, Colo., will discuss these potential benefits tomorrow afternoon in his presentation, “A Practical Approach to Managing Prediabetes: Identifying and Treating High-Risk Patients.” He will propose practical strategies for implementing diagnostic criteria, discuss the benefits of early diagnosis, and recommend treatment modalities for patients with prediabetes.

While multiple risk models have been developed for prediabetes, none have been universally accepted. It’s been established that ethnic origin is strongly related to diabetes risk, and additional risk factors in one or more models include:

• Age, sex, body mass index, diet, physical inactivity, or smoking.

• Family history of diabetes.

• Hypertension, antihypertensive treatment, or cardiovascular disease.

• Low HDL cholesterol, high triglycerides, or uric acid.

Milligan will explain how the use of an individualized risk evaluation allows you to determine whom to screen for prediabetes. Examining the global risk for coronary heart disease and stroke enables you to determine how aggressive treatment for CVD risk factors needs to be.

Blood pressure is an important predictor of complications of CVD in patients with type 2 diabetes and should be used as the first step in applying this recommendation. It’s generally suggested that you screen all patients who have a sustained blood pressure of 135/80 mm Hg.

Three tests are used to screen for diabetes: FPG, 2-hour postload plasma glucose, and HbA1c. Experts suggest that the FPG test is easier, faster to perform, more convenient and acceptable to patients, and less expensive than other screening tests. However, as with any screening test, each has its own advantages and disadvantages.

While the optimal screening interval has yet to be determined, the ADA recommends a 3-year interval, based on expert opinion. For patients with prediabetes, at least annual monitoring is suggested.

Identifying patients with prediabetes may not improve long-term microvascular or macrovascular complications, but regardless of whether the clinician decides to screen for diabetes, patients should eat a healthy diet, engage in an active lifestyle, and maintain a healthy weight as these behaviors have other benefits in addition to preventing or delaying the onset of type 2 diabetes.

— Colleen Mullarkey