People with prediabetes, people with components of metabolic syndrome, women who have had gestational diabetes, and people with a strong family history of diabetes are at risk for developing type 2 diabetes (Rosenzweig et al., 2008). With good clinical care and education, people with prediabetes can slow or prevent the progression to diabetes with a proactive regimen (ADA, 2015). The first step is recognizing prediabetes in people at risk.
Identifying People at Risk
National studies show that 1 in 3 adults have prediabetes and only 1 in 10 are aware of the diagnosis. Since 1997 the ADA has recognized the existence of levels of glucose elevation that are out of the normal range, but not yet at levels diagnostic for diabetes. These individual are at increased risk for the same target organ damage as those clinically diagnosed with diabetes. In contrast to newer guidelines that support use of the A1c in diagnosing diabetes, the newest American Association of Clinical Endocrinologists (AACE, 2016) recommend continued use of fasting plasma glucose or the 2-hour OGG to make the diagnosis of prediabetes. Newer ADA guidelines recognize A1c levels between 5.7% and 6.4% as being consistent with the diagnosis of prediabetes. Various professional groups recommend that the following people be screened for prediabetes at least every three years:
- All people >45 years old
- Women with a history of gestational diabetes or those delivering an infant >9 lb
- Adults with blood pressures of systolic >135 mm Hg or diastolic >80 mm Hg
- Adults with dyslipidemia
- People with a BMI >25
- People with a large waist circumference > 35 in
- People with a strong family history of diabetes (type 2 diabetes in a first- or second-degree relative)
- People of ethnic groups that are especially prone to diabetes: Native American, African American, Latino, Asian American, or Pacific Islander (USPSTF, 2008; ADA, 2015)
Proactive Management of Prediabetes
In partnership with the CDC, the diabetes prevention program (DPP) teaches people in a twelve-month program to implement lifestyle change. Studies have shown that those involved in the program lost weight and decreased their risk in developing diabetes.
People with prediabetes should lose weight, increase their physical activity, modify their diets by increasing dietary fiber, and reduce calories, saturated fats, and trans fats. A clinician may consider the addition of metformin as an adjunct to lifestyle changes. Additionally, patients should reduce their cardiovascular risk factors by reducing their blood pressure to below 130/80 mm Hg and correcting any dyslipidemia.
These interventions can be difficult for patients to follow for long periods. The most effective treatment regimens include frequent contact between patients and their diabetes team members. Prediabetes patients also need regular visits with their physician. Studies show that with proactive care the incidence of type 2 diabetes can be reduced by 40% to 50% (Guangwei et al., 2008).
- Reversing insulin resistance with chromium supplements and antioxidants.
- Slowing or stopping the progression of prediabetes to type 2 diabetes.
- Giving insulin injections to people at risk for developing type 2 diabetes.
- Treating chronic complications, such as diabetic kidney disease, before they begin.
What can you do in your current professional role to advocate for decreasing prediabetes in your patients, and even yourself?