Constance Young. New considerations in metabolic syndrome and prediabetes. J Am Osteopath Assoc 2010;110(3_suppl_3):eS23–eS25. doi: .
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New guidelines set
The American Diabetes Association's “Current Guidelines for Pre-Diabetes,” from its position statement, “Standards of Medical Care in Diabetes revised in 2010.”
Tests for prediabetes
▪ FPG and OGTT
Both the Fasting Plasma Glucose [FPG*] test and the two-hour Oral Glucose Tolerance Test [OGTT**] are appropriate for prediabetes testing. The two-hour OGTT identifies people with either impaired fasting glucose or impaired glucose tolerance; therefore it picks up more prediabetic people at increased risk for the development of diabetes and cardiovascular disease than the FPG test. On the other hand, the two tests do not necessarily detect the same prediabetic individuals.
▪ Impaired fasting glucose (IFG)
A fasting glucose level between 100 and 125 mg/dL indicates (IFG).
▪ Impaired glucose tolerance (IGT)
A two-hour post-75-g glucose load/glucose concentration of between 140 to 199 mg/dL indicates, prediabetes both IFG and IGT fall into the official diagnosis of “prediabetes,” and both are risk factors for future diabetes.
The ADA now promotes the use of the hemoglobin A1c (A1c) test to help reduce the number of undiagnosed patients and better identify people with prediabetes because that test is faster and easier than other diabetes tests.
▪ An A1c of 5.7 to 6.4 % suggests an increased risk for future diabetes, or prediabetes, and the cut-off point of 6.5 % and above indicates diabetes.
*The screening test of choice for diagnosing diabetes mellitus is the FPG test because it is simpler, more accurate, less expensive, and less variable than the two-hour OGTT, which is not necessary to diagnose diabetes and should rarely be used.
**The OGTT test may be useful however in patients with IFG to better define the risk of diabetes and CVD.
▪ Lifestyle changes
Prediabetes is a major risk factor associated with metabolic syndrome. For patients with prediabetes, the goal is to decrease the risk of diabetes and cardiovascular disease by promoting physical activity and healthy food choices that result in moderate sustainable weight loss, or at a minimum, prevents further weight gain. Patients identified with prediabetes, should be tested and treated for other potential CVD risk factors.
The ADA does not recommend drug therapy owing to the limited efficacy of treatment versus lifestyle modification, the potential for adverse drug reactions, and the lack of data supporting reduction of microvascular or macrovascular complications of diabetes in this patient population, as well as insufficient assessment of the cost-effectiveness of drug treatment.
Since not all patients are able to implement lifestyle modifications for various reasons, and based on limited data available, drug therapy may be a reasonable option to delay onset of type 2 diabetes and provide a cardiovascular benefit.
Source: American Diabetes Associaiton, “Standards of Medical Care in Diabetes-2010”.
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