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Prediabetes Guidelines

Friday, October 29, 2010 // Uncategorized

10/27/2008 12:00:00 AM

Often patients are noted to have a blood glucose on a chemistry panel that is above the upper limits of normal that is above 99.  About 4 years ago the upper limits of normal was considered to be 109.  People whose blood glucose is above normal, but does not meet the definition of diabetes i.e, a fasting blood glucose of 126 or greater, are said to have impaired fasting glucose or prediabetes.  A significant percentage of these patients will go on to develop diabetes.  These patients have a risk of cardiovascular disease that is 1.5 times the normal risk. That means that if you calculate the 10 year risk for having a heart attack, if the blood glucose is in the range of 99-126, you multiply the number by 1 1/2.

The most effective way of preventing the development of diabetes is, surprise, proper diet and exercise!  The following is a summary of the new guidelines for the management of this condition:

Consensus Statement Issued for Managing Prediabetes
The American College of Endocrinology has issued its first guidelines for management of patients with prediabetes.

Among the recommendations:

Patients with prediabetes (fasting glucose: 100–125 mg/dL; or 2-hour post-glucose challenge: 140–199 mg/dL) should undergo annual glucose tolerance and microalbuminuria testing.
Fasting plasma glucose, hemoglobin A1c, and lipids should be checked every 6 months.
As first-line treatment, patients should reduce their weight by 5%–10%, exercise for 30 to 60 minutes 5 days a week, and follow a low-fat, high-fiber diet.
For high-risk patients (e.g., those with worsening glycemia or cardiovascular disease), metformin and acarbose may be considered.
Lipid targets are the same as for patients with diabetes (e.g., LDL: 100 mg/dL); statins are recommended.
Blood pressure targets are also the same as for diabetic patients (systolic BP: <130 mm Hg; diastolic: 80 mm Hg), and ACE inhibitors and angiotensin receptor blockers should be considered first-line agents.
Prediabetes consensus statement (Free PDF)
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