Pre-DM is a risk factor for DM, and not a disease itself.
Diagnosis
-A1C 5.7 to 6.4 % / FBS 100-125 / impaired glucose tolerance.
-Confirm the dx of pre-DM or DM type 2 by repeating the same test on a different day.
-The patient is at risk of progression from pre-DM to DM.
Treatment
-Patient counseled on lifestyle changes to achieve a 7% weight loss and moderate-intensity physical activity of at least 150 minutes per week.
-Consider Metformin, acarbose (a glucosidase inhibitor), orlistat, and thiazolidinediones to reduce the risk of developing diabetes.
-F/u in 3-6 mo.
—/END/—
- Medications that will reduce the risk of developing diabetes in a prediabetic patient are: Metformin, acarbose (a glucosidase inhibitor), orlistat, and thiazolidinediones.
- Impaired fasting plasma glucose = 100 to 125 mg per dL (5.6 to 6.9 mmol per L)
Impaired glucose tolerance: two-hour plasma glucose in the 75-g OGTT = 140 to 199 mg per dL (7.8 to 11.0 mmol per L) - “Metformin, thiazolidinediones, and α-glucosidase inhibitors were all found to be effective in preventing or delaying progression to type 2 diabetes” USPSTF
- “The diagnosis of IFG, IGT, or type 2 diabetes should be confirmed; repeated testing with the same test on a different day is the preferred method of confirmation.” USPSTF
- Typical presentation: Morbidly obese female. A1C 6.0. She can’t tolerate Metformin. What drugs can be used to reduce her risk of developing diabetes mellitus? Acarbose Precose)
- “Individuals with impaired fasting glucose or impaired glucose tolerance have a higher risk of developing diabetes mellitus in the future. Randomized, controlled trials have shown that taking metformin, α-glucosidase inhibitors (acarbose), orlistat, or thiazolidinediones significantly reduces the risk of developing diabetes mellitus. The U.S. Diabetes Prevention Program Outcomes Study demonstrated a 34% reduction in the development of diabetes mellitus at 10 years. In addition to medications, it is also recommended that patients be counseled about weight loss and engaging in moderate physical activity for at least 150 minutes per week. The other medications listed are indicated for the treatment of diabetes but have not been shown to be effective for prevention.”ABFM
References
http://www.diabetes.org/diabetes-basics/diagnosis/
https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/screening-for-abnormal-blood-glucose-and-type-2-diabetes
Am Fam Physician. 2004 Apr 15;69(8):1961-1968. http://www.aafp.org/afp/2004/0415/p1961.html
Am Fam Physician. 2017 Jan 1;95(1):40-43. http://www.aafp.org/afp/2017/0101/p40.html
Am Fam Physician. 2016 Jan 15;93(2):103-109. http://www.aafp.org/afp/2016/0115/p103.html
JAMA 2003;290(4):486-494. Acarbose treatment and the risk of cardiovascular disease and hypertension in patients with impaired glucose tolerance: The STOP-NIDDM Trial.
Diabetes Care 2016;39(Suppl 1): S36-S38. American Diabetes Association: Standards of Medical Care in Diabetes—2016. 4. Prevention or delay of type 2 diabetes.