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prediabetes

Term coined by the American Diabetes Association & the National Institutes of Health referring to persons whose blood glucose is higher than normal, but not high enough to reach criteria for diabetes mellitus. Epidemiology: - 38% if Americans with prediabetes [13] Laboratory: 1) fasting plasma glucose:* 100-125 mg/dL 2) oral glucose tolerance test (2 hour): 140-199 mg/dL 3) hemoglobin A1c of 5.7-6.4% [5] * previously 110 mg/dL Complications: 1) most of these persons will develop diabetes within 10 years - prediabetes does not predict diabetes risk in older adults [18] 2) higher risk of heart disease & stroke (RR = 1.2) [7,15] 3) peripheral neuropathy - prevalence based on Michigan Neuropathy Screening Instrument scores = 49%* - in analysis based on neurothesiometer readings, prevalence = 5-10% not different from euglycemic subjects [11] * 29& in euglycemic subjects & 50% in diabetics Management: 1) life-style changes prevent progress to type 2 diabetes (41% vs 58%) [4] - see prevention of diabetes 2) modest weight loss 3) modest aerobic exercise 4) patients with prediabetes who achieve normal glucose regulation, even transiently, are less likely to develop diabetes [6] 5) short bouts of walking (15 minutes) after meals may be more effective than a single longer walk (45 minutes) in controlling postprandial hyperglycemia in older adults [8] 6) American Diabetes Association recommendations - nutritional therapy [17] - metformin for treatment of prediabetes in patients < 60 years, BMI > 35, or with history of gestational diabetes [4] - metformin prevents or delays progression to diabetes in some prediabetic patients [11] - shown to delay onset of diabetes by up to 3 years [4]* - lifestyle interventions more effective than metformin in preventing progression to overt diabetes mellitus type-2 - orlistat, acabose or voglibose, or thiazolidinedione also shown to delay onset of diabetes by up to 3 years [4] 7) lorcaserin (Belviq) may promote weight loss & slow progression to type 2 diabetes & promote remission of type 2 diabetes [16] 8) vitamin D of no benefit in preventing progression of prediabetes to type 2 diabetes 9) after 21 years of followup, mortality similar in patients with prediabetes randomized to lifestyle intervention, metformin, or placebo [19] * preferred over diet & lifestyle changes [4], orlistat, acarbose or thiazolidinediones (no references cited)

Interactions

disease interactions

Related

diabetes mellitus impaired fasting glucose impaired glucose tolerance risk factors for diabetes mellitus type 2 & risk factor reduction

General

endocrine disease

References

  1. Prescriber's Letter 9(4):19 2002
  2. Prescriber's Letter 11(1):1 2004 Detail-Document#: 200106 (subscription needed) http://www.prescribersletter.com
  3. Prescriber's Letter 15(9): 2008 Diagnosis and Treatment of Pre-diabetes Detail-Document#: 240906 (subscription needed) http://www.prescribersletter.com
  4. Medical Knowledge Self Assessment Program (MKSAP) 14, 16, 17, 18, 19. American College of Physicians, Philadelphia 2006, 2012, 2015, 2018, 2022.
  5. Heianza Y et al. HbA1c 5 7-6 4% and impaired fasting plasma glucose for diagnosis of prediabetes and risk of progression to diabetes in Japan (TOPICS 3): A longitudinal cohort study. Lancet 2011 Jun 25; PMID: 21705064 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60472-8/fulltext
  6. Perreault L et al Effect of regression from prediabetes to normal glucose regulation on long-term reduction in diabetes risk: results from the Diabetes Prevention Program Outcomes Study The Lancet, Early Online Publication, 9 June 2012 PMID: 22683134 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60525-X/fulltext - Yakubovich N and Gerstein HC Is regression to normoglycaemia clinically important? The Lancet, Early Online Publication, 9 June 2012 PMID: 22683127 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60828-9/fulltext
  7. Lee M et al. Effect of pre-diabetes on future risk of stroke: Meta-analysis. BMJ 2012 Jun 7; 344:e3564. PMID: 22677795
  8. DiPietro L et al Three 15-min Bouts of Moderate Postmeal Walking Significantly Improves 24-h Glycemic Control in Older People at Risk for Impaired Glucose Tolerance. Diabetes Care. 2013 Oct 36:3262 PMID: 23761134 http://care.diabetesjournals.org/content/early/2013/06/03/dc13-0084.abstract
  9. Moin T et al. Metformin prescription for insured adults with prediabetes from 2010 to 2012: A retrospective cohort study. Ann Intern Med 2015 Apr 21; 162:542 PMID: 25894024
  10. Sussman JB et al Improving diabetes prevention with benefit based tailored treatment: risk based reanalysis of Diabetes Prevention Program. BMJ 2015;350:h454 PMID: 25697494 http://www.bmj.com/content/350/bmj.h454
  11. Brett AS Peripheral Neuropathy in Patients with Prediabetes NEJM Journal Watch. June 4, 2015 Massachusetts Medical Society (subscription needed) http://www.jwatch.org - Lee CC et al. Peripheral neuropathy and nerve dysfunction in individuals at high risk for type 2 diabetes: The PROMISE cohort. Diabetes Care 2015 May; 38:793 PMID: 25665810 http://care.diabetesjournals.org/content/38/5/793
  12. New AMA, CDC Initiative Aims to "Prevent Diabetes STAT" http://www.cdc.gov/media/releases/2015/p0311-diabetes-stat.html
  13. Menke A et al Prevalence of and Trends in Diabetes Among Adults in the United States, 1988=2012. JAMA. 2015;314(10):1021-1029 PMID: 26348752 http://jama.jamanetwork.com/article.aspx?articleid=2434682 - Herman WH, Rothberg AE Prevalence of Diabetes in the United States. A Glimmer of Hope? JAMA. 2015;314(10):1005-1007. PMID: 26348749 http://jama.jamanetwork.com/article.aspx?articleid=2434665
  14. Jorde R et al. Vitamin D 20 000 IU per week for five years does not prevent progression from prediabetes to diabetes. J Clin Endocrinol Metab 2016 Apr; 101:1647. PMID: 26829443
  15. Huang Y, Cai X, Mai W, Li M, Hu Y. Association between prediabetes and risk of cardiovascular disease and all cause mortality: systematic review and meta- analysis. BMJ 2016;355:i5953 PMID: 27881363 Free full text http://www.bmj.com/content/355/bmj.i5953
  16. Bohula EA et al. Effect of lorcaserin on prevention and remission of type 2 diabetes in overweight and obese patients (CAMELLIA-TIMI 61): A randomised, placebo-controlled trial. Lancet 2018 Oct 4; PMID: 30293771 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32328-6/fulltext - Unamuno X, Fruhbeck G. Lorcaserin: Balancing efficacy with potential risks. Lancet 2018 Oct 4 PMID: 30293772 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32460-7/fulltext
  17. Evert AB, Dennison M, Gardner CD et al Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report. Diabetes Care 2019 May; 42(5): 731-754 PMID: 31000505 http://care.diabetesjournals.org/content/42/5/731
  18. Rooney MR, Rawlings AM, Pankow JS et al Risk of Progression to Diabetes Among Older Adults With Prediabetes. JAMA Intern Med. Published online February 8, 2021. PMID: 33555311 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2775594 - Lam K, Lee SJ. Prediabetes - A Risk Factor Twice Removed. JAMA Intern Med. Published online February 8, 2021. PMID: 33555307 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2775591
  19. Lee CG, Heckman-Stoddard B, Dabelea D et al. Effect of metformin and lifestyle interventions on mortality in the diabetes prevention program and diabetes prevention program outcomes study. Diabetes Care 2021 Dec; 44:2775. PMID: 34697033 PMCID: PMC8669534 (available on 2022-12-01) https://diabetesjournals.org/care/article/44/12/2775/138471/Effect-of-Metformin-and-Lifestyle-Interventions-on
  20. American Diabetes Association Prevention or Delay of Type 2 Diabetes: Standards of Medical Care in Diabetes-2018 Diabetes Care. 2018 Jan;41(Suppl 1):S51-S54. Review. PMID: 29222376 - American Diabetes Association. 3. Prevention or delay of type 2 diabetes: standards of medical care in diabetes-2020 Diabetes Care. 2020;43(Suppl 1):S32-S36 PMID: 31862746 Review. https://diabetesjournals.org/care/article/43/Supplement_1/S32/30500/3-Prevention-or-Delay-of-Type-2-Diabetes-Standards - American Diabetes Association 3. Prevention or Delay of Type 2 Diabetes: Standards of Medical Care in Diabetes-2021 PMID: 33298414
  21. NEJM Knowledge+ - Knowler WC, Barrett-Connor E, Fowler SE et al Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002 Feb 7;346(6):393-403. doi: 10.1056/NEJMoa012512. PMID: 11832527 PMCID: PMC1370926 Free PMC article. Clinical Trial. https://www.nejm.org/doi/pdf/10.1056/NEJMoa012512
  22. Prevent Diabetes STAT (Screen, Test, Act Today) http://www.ama-assn.org/sub/prevent-diabetes-stat/index.html - Prevent Diabetes STAT Toolkit http://www.ama-assn.org/sub/prevent-diabetes-stat/toolkit.html
  23. Insulin Resistance and Pre-Diabetes http://diabetes.niddk.nih.gov/dm/pubs/insulinresistance/index.htm