New guidelines from two major endocrinology organizations recommend strategies for diagnosis and management of prediabetes, a condition that occurs when blood glucose levels are higher than normal but not elevated enough to warrant a diagnosis of type 2 diabetes.

Incidence of diabetes is increasing, with 24.1 million people, or nearly 8% of the population, now suffering from the disease, according to the American Diabetes Association. The 57 million pre-diabetic Americans are at risk of developing diabetes and its myriad complications, including difficulty seeing and blindness, vascular problems that can lead to amputations, and kidney disease. Many prediabetics also suffer from these complications, even though their blood glucose levels remain below those that define diabetes, according to the guidelines from the American College of Endocrinology and the American Association of Clinical Endocrinologists (AACE).

“The data show that there is a spectrum of severity, with the most severely affected approaching the risks of people with diagnosed type 2 diabetes,” said Daniel Einhorn, MD, FACP, FACE, Vice President of AACE and Medical Director of the Scripps Whittier Institute for Diabetes in La Jolla, CA. “In these highest risk-individuals, who represent a minority, pharmacologic strategies may be appropriate if intensive lifestyle therapies fail. Regardless, all individuals at risk for diabetes should be aware of the level of their risk factors and be prepared to take action.”

The guidelines are an extension of efforts to detect and treat type 2 diabetes earlier and more aggressively, according to AACE. They aim to help physicians recognize prediabetes, those at risk for developing full-blown diabetes, and to make treatment decisions to prevent diabetes and ameliorate many of its risk factors. These include unhealthy weight, high blood pressure, and elevated lipid levels.

Consistent with guidelines from the American Diabetes Associations, the guidelines say patients with fasting glucose levels of 100-125 mg/dL or two-hour post-glucose challenge levels of 140-199 mg/dL should be diagnosed with prediabetes. Once diagnosed, these patients should get glucose tolerance and microalbuminuria tests every 12 months and fasting plasma glucose, hemoglobin A1c, and lipid readings every 6 months.

Regarding blood lipid and blood pressure levels, recommendations are the same as for diabetics. LDL cholesterol should be 100 mg/dL or below, non-HDL cholesterol less than 130 mg/dL, and apolipoprotein B at 90 mg/dL or below. The guidelines recommend statins to help achieve these goals. For blood pressure, the target is below 130/80 mm/Hg.

The guidelines emphasize an intensive lifestyle management approach to prevent both cardiovascular complications and progression to type 2 diabetes. Treatment aims for a weight reduction of 5% to 10%, exercise for 30 to 60 minutes a day five days a week and a low-fat, high-fiber diet. Patients should also lower sodium intake and avoid excess drinking of alcoholic beverages, the guidelines advise.

“Prevention of diabetes is a key strategy for reducing patient suffering and the high social costs of the disease,” the guidelines emphasize. “It is incumbent upon health care systems and health providers to develop lifestyle intervention programs that prevent diabetes, given the current basis of evidence.”

Sources

American College of endocrinology Consensus Statement of the Diagnosis and Management of Pre-Diabetes in the Continuum of Hyperglycemia--When Do the risks of Diabetes Begin? PDF available for download at http://www.aace.com/meetings/consensus/hyperglycemia/hyperglycemia.pdf through http://www.aace.com. Issued July 23, 2008. Accessed September 16, 2008.

American Association of Clinical Endocrinologists. Press Release: Diabetes Experts Recommend One-Two Punch for Treating Patients with Pre-Diabetes. Available online at http://media.aace.com/article_display.cfm?article_id=4828 through http://media.aace.com. Issued July 23, 2008. Accessed September 16, 2008.

American Diabetes Association. Frequently Asked Questions About Prediabetes. Available online at http://www.diabetes.org/pre-diabetes/faq.jsp through http://www.diabetes.org. Accessed September 16, 2008.