Pre-diabetes
Pre-diabetes describes a condition in which blood glucose levels are higher than normal, although not high enough to be diagnosed with type 2 diabetes. Pre-diabetes has no signs or symptoms. People with pre-diabetes have a higher risk of developing type 2 diabetes and cardiovascular (heart and circulation) disease. Two million Australians have pre-diabetes and are at high-risk of developing type 2 diabetes. Without sustained lifestyle changes, including healthy eating, increased activity and losing weight, approximately one in three people with pre-diabetes will go on to develop type 2 diabetes. There are two pre-diabetes conditions: Impaired glucose tolerance (IGT) is where blood glucose levels are higher than normal but not high enough to be classified as diabetes. Impaired fasting glucose (IFG) is where blood glucose levels are escalated in the fasting state but not high enough to be classified as diabetes. It is possible to have both Impaired Fasting Glucose (IFG) and Impaired Glucose Tolerance (IGT) Risk factors for pre-diabetes are similar to those for type 2 diabetes which are: Being overweight – especially those who have excess weight around the waistline (ie: more than 94cm for men and more than 80cm for women). Being physically inactive. Having high triglycerides and low HDL-C (good cholesterol) and/or high total cholesterol. Having high blood pressure. Having a family history of type 2 diabetes and/or heart disease. Women with Polycystic Ovarian Syndrome*. Women who have had diabetes in pregnancy (gestational diabetes) or given birth to a big baby (more than 4.5kgs). Those from Aboriginal and Torres Strait Islander background. Those from certain ethnic backgrounds such as the Pacific Islands, Asia and the Indian sub-continent. For more information refer to Continue reading >>
Prediabetes/ Type 2 Diabetes Treatment Guidelines For Professionals
Below is a summary of the American Diabetes Association (ADA) dietary treatment guidelines (Standards of Medical Care in Clinical Practice 2017) for adults with type 2 diabetes mellitus and how Diabetes Meal Plans (DMP) aims to meet, and assist providers and healthcare professionals to meet those clinical guidelines. Uniting to support people’s health It’s our duty as healthcare educators and professionals to guide people in a positive direction and provide them with the support and guidance they need to change habits. One essential factor to recognize is that type 2 diabetes and prediabetes is largely a self-managed process. Therefore, people need to be enabled with knowledge, skills and tools to manage their condition. One of the key areas they need to gain this knowledge and skill is around diet and food. Quite simply because healthful eating is one of the core elements of self-care behavior. But, “for many individuals with diabetes, the most challenging part of the treatment plan is determining what to eat and following a food plan. (ADA S34).” Quite frankly, most information on the web is too generic, difficult to understand, and overwhelming for the newly diagnosed, the long-term diabetic, and prediabetic people alike. It is our duty to help guide them in a positive direction and provide education and resources that people can actually apply to their every day lives, which is exactly what we do here at DMP. ADA recommends that “each person with diabetes be actively engaged in self-management, education, and treatment planning with his or her health care provider, which includes the collaborative development of an individualized eating plan.” The overall objectives of education are to support: Informed decision making Self-care behaviors Problem solving Continue reading >>
- Early Warning Signs of Diabetes That Most Medical Professionals Don’t Even Know
- Diabetes Health Professionals
- Relative effectiveness of insulin pump treatment over multiple daily injections and structured education during flexible intensive insulin treatment for type 1 diabetes: cluster randomised trial (REPOSE)
The Right Diet For Prediabetes
A prediabetes diagnosis can be alarming. This condition is marked by abnormally high blood sugar (glucose) most often due to insulin resistance. This is a condition in which the body doesn’t use insulin properly. It’s often a precursor to type 2 diabetes. According to the Mayo Clinic, people with prediabetes are more likely to develop type 2 diabetes within 10 years. With prediabetes, you may also be at risk of developing cardiovascular disease. However, a prediabetes diagnosis doesn’t mean you will definitely get type 2 diabetes. The key is early intervention; to get your blood sugar out of the prediabetes range. Your diet is important, and you need to know the right kind of foods to eat. How diet relates to prediabetes There are many factors that increase your risk for prediabetes. Genetics can play a role, especially if diabetes runs in your family. Excess body fat and a sedentary lifestyle are other potential risk factors. In prediabetes, sugar from food begins to build up in your bloodstream because insulin can’t easily move it into your cells. Eating carbohydrates doesn’t cause prediabetes. But a diet filled with carbohydrates that digest quickly can lead to blood sugar spikes. For most people with prediabetes, your body has a difficult time lowering blood sugar levels after meals. Avoiding blood sugar spikes can help. When you eat more calories than your body needs, they get stored as fat. This can cause you to gain weight. Body fat, especially around the belly, is linked to insulin resistance. This explains why many people with prediabetes are also overweight. You can’t control all risk factors for prediabetes, but some can be mitigated. Lifestyle changes can help you maintain balanced blood sugar levels as well as a healthy weight. Watch carbs with Continue reading >>
Metformin For Prediabetes
Prediabetes is, for many people, a confusing condition. It’s not quite Type 2 diabetes — but it’s not quite nothing, either. So how concerned should you be about it? For years, the jargon-filled names given to this condition — impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) — may have made the task of taking it seriously more difficult. But in 2002, the American Diabetes Association (ADA), along with the U.S. Department of Health and Human Services, inaugurated the term “prediabetes” to convey the likely result of not making diet or lifestyle changes in response to this diagnosis. In 2003, the threshold for prediabetes was lowered from a fasting glucose level of 110 mg/dl to one of 100 mg/dl. Then, in 2008, the American Diabetes Association (ADA) began recommending the drug metformin for some cases of prediabetes — specifically, for people under age 60 with a very high risk of developing diabetes, for people who are very obese (with a body-mass index, or BMI, of 35 or higher), and for women with a history of gestational diabetes. The ADA also said that health-care professionals could consider metformin for anyone with prediabetes or an HbA1c level (a measure of long-term blood glucose control) between 5.7% and 6.4%. But according to a recent study, metformin is still rarely prescribed for prediabetes. The study, published in April in the journal Annals of Internal Medicine, found that only 3.7% of people with prediabetes were prescribed metformin over a three-year period, based on data from a large national sample of adults ages 19 to 58. According to a Medscape article on the study, 7.8% of people with prediabetes with a BMI of 35 or higher or a history of gestational diabetes were prescribed metformin — still a very low rate for t Continue reading >>
Jabfp | Mobile
Purpose: Detection and treatment of prediabetes is an effective strategy in diabetes prevention. However, most patients with prediabetes are not identified. Our objective was to evaluate the relationship between attitudes toward prediabetes as a clinical construct and screening/treatment behaviors for diabetes prevention among US family physicians. Methods: An electronic survey of a national sample of academic family physicians (n 1248) was conducted in 2016. Attitude toward prediabetes was calculated using a summated scale assessing agreement with statements regarding prediabetes as a clinical construct. Perceived barriers to diabetes prevention, current strategies for diabetes prevention, and perceptions of peers were also examined. Results: Physicians who have a positive attitude toward prediabetes as a clinical construct are more likely to follow national guidelines for screening (58.4% vs 44.4; P < .0001) and recommend metformin to their patients for prediabetes (36.4% vs 20.9%; P < .0001). Physicians perceived a number of barriers to treatment, including a patient's economic resources (71.9%), sustaining patient motivation (83.2%), a patient's ability to modify his or her lifestyle (75.3%), and time to educate patient (75.3%) as barriers to diabetes prevention. Conclusions: How physicians view prediabetes varies significantly, and this variation is related to treatment/screening behaviors for diabetes prevention. This study analyzed a survey conducted as part of the Council of Academic Family Medicine (CAFM) Educational Research Alliance (CERA). CERA is a joint initiative of all 4 major US academic family medicine organizations (the Society of Teachers of Family Medicine, the North American Primary Care Research Group, the Association of Departments of Family Med Continue reading >>
Diagnosis
Print The American Diabetes Association (ADA) recommends that blood glucose screening for adults begin at age 45, or sooner if you are overweight and have additional risk factors for prediabetes or type 2 diabetes. There are several blood tests for prediabetes. Glycated hemoglobin (A1C) test This test indicates your average blood sugar level for the past two to three months. Specifically, the test measures the percentage of blood sugar attached to the oxygen-carrying protein in red blood cells (hemoglobin). The higher your blood sugar levels, the more hemoglobin you'll have with sugar attached. In general: An A1C level below 5.7 percent is considered normal An A1C level between 5.7 and 6.4 percent is considered prediabetes An A1C level of 6.5 percent or higher on two separate tests indicates type 2 diabetes Certain conditions can make the A1C test inaccurate — such as if you are pregnant or have an uncommon form of hemoglobin (hemoglobin variant). Fasting blood sugar test A blood sample is taken after you fast for at least eight hours or overnight. In general: A fasting blood sugar level below 100 milligrams per deciliter (mg/dL) — 5.6 millimoles per liter (mmol/L) — is considered normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 7.0 mmol/L) is considered prediabetes. This result is sometimes called impaired fasting glucose. A fasting blood sugar level of 126 mg/dL (7.0 mmol/L) or higher indicates type 2 diabetes. Oral glucose tolerance test This test is usually used to diagnose diabetes only during pregnancy. A blood sample is taken after you fast for at least eight hours or overnight. Then you'll drink a sugary solution, and your blood sugar level will be measured again after two hours. In general: A blood sugar level less than 140 mg/dL (7.8 mmo Continue reading >>
Management Of Prediabetes
Treatment Goals The primary goal of prediabetes management is to normalize glucose levels and prevent or delay progression to diabetes and associated microvascular complications (1,2). Management of common prediabetes comorbidities such as obesity, hypertension, dyslipidemia, cardiovascular disease, and chronic kidney disease is also essential. Therapeutic Lifestyle Management Given its safety and the strength of evidence for its effectiveness in improving glycemia and reducing cardiovascular disease (CVD) risk factors, the preferred treatment approach for prediabetes is intensive lifestyle management (1,2). Therapeutic lifestyle management should be discussed with all patients with prediabetes at the time of diagnosis and throughout their lifetimes. Therapeutic lifestyle management includes medical nutrition therapy (MNT; the reduction and modification of caloric and saturated/hydrogenated fat intake to achieve weight loss in individuals who are overweight or obese), appropriately prescribed physical activity, avoidance of tobacco products, adequate quantity and quality of sleep, limited alcohol consumption, and stress reduction (2). While lifestyle modifications may be difficult to maintain, the following strategies have been shown to increase the likelihood of patient success (1,2): Patient self-monitoring Realistic and stepwise goal setting Stimulus control Cognitive strategies Social support Appropriate reinforcement Primary care providers (PCPs) often take on the responsibility of encouraging behavior changes. The Avoiding Diabetes Through Action Plan Targeting (ADAPT) trial has developed a system that combines evidence-based interventions for behavioral change with existing health record technology to improve primary care providers’ ability to effectively couns Continue reading >>
Prediabetes Diagnosis And Treatment: A Review
Go to: Abstract Prediabetes is an intermediate state of hyperglycemia with glycemic parameters above normal but below the diabetes threshold. While, the diagnostic criteria of prediabetes are not uniform across various international professional organizations, it remains a state of high risk for developing diabetes with yearly conversion rate of 5%-10%. Observational evidence suggests as association between prediabetes and complications of diabetes such early nephropathy, small fiber neuropathy, early retinopathy and risk of macrovascular disease. Several studies have shown efficacy of lifestyle interventions with regards to diabetes prevention with a relative risk reduction of 40%-70% in adults with prediabetes. While there is increasing evidence to prove the efficacy of pharmacotherapy in prevention of diabetes in adults with prediabetes, pharmaceutical treatment options other than metformin are associated with adverse effects that limit their use for prediabetes. There are no reports of systematic evaluation of health outcomes related to prediabetes in children. The effects of pharmacotherapy of prediabetes on growth and pubertal development in children remains unknown. Secondary intervention with pharmacotherapy with metformin is advocated for high-risk individuals but criteria for such consideration benefit of early intervention, long term cost effectiveness of such interventions and the end point of therapy remain unclear. Pharmacotherapy must be used with caution in children with prediabetes. Prediabetes is a condition defined as having blood glucose levels above normal but below the defined threshold of diabetes. It is considered to be an at risk state, with high chances of developing diabetes. While, prediabetes is commonly an asymptomatic condition, there is a Continue reading >>
Prediabetes
What Is Prediabetes? Prediabetes is a “pre-diagnosis” of diabetes—you can think of it as a warning sign. It’s when your blood glucose level (blood sugar level) is higher than normal, but it’s not high enough to be considered diabetes. Prediabetes is an indication that you could develop type 2 diabetes if you don’t make some lifestyle changes. But here's the good news: . Eating healthy food, losing weight and staying at a healthy weight, and being physically active can help you bring your blood glucose level back into the normal range. Diabetes develops very gradually, so when you’re in the prediabetes stage—when your blood glucose level is higher than it should be—you may not have any symptoms at all. You may, however, notice that: you’re hungrier than normal you’re losing weight, despite eating more you’re thirstier than normal you have to go to the bathroom more frequently you’re more tired than usual All of those are typical symptoms associated with diabetes, so if you’re in the early stages of diabetes, you may notice them. Prediabetes develops when your body begins to have trouble using the hormone insulin. Insulin is necessary to transport glucose—what your body uses for energy—into the cells via the bloodstream. In pre-diabetes, your body either doesn’t make enough insulin or it doesn’t use it well (that’s called insulin resistance). If you don’t have enough insulin or if you’re insulin resistant, you can build up too much glucose in your blood, leading to a higher-than-normal blood glucose level and perhaps prediabetes. Researchers aren’t sure what exactly causes the insulin process to go awry in some people. There are several risk factors, though, that make it more likely that you’ll develop pre-diabetes. These are Continue reading >>
Management Of Blood Glucose With Noninsulin Therapies In Type 2 Diabetes
A comprehensive, collaborative approach is necessary for optimal treatment of patients with type 2 diabetes mellitus. Treatment guidelines focus on nutrition, exercise, and pharmacologic therapies to prevent and manage complications. Patients with prediabetes or new-onset diabetes should receive individualized medical nutrition therapy, preferably from a registered dietitian, as needed to achieve treatment goals. Patients should be treated initially with metformin because it is the only medication shown in randomized controlled trials to reduce mortality and complications. Additional medications such as sulfonylureas, dipeptidyl-peptidase-4 inhibitors, thiazolidinediones, and glucagon-like peptide-1 receptor agonists should be added as needed in a patient-centered fashion. However, there is no evidence that any of these medications reduce the risk of diabetes-related complications, cardiovascular mortality, or all-cause mortality. There is insufficient evidence on which combination of hypoglycemic agents best improves health outcomes before escalating to insulin therapy. The American Diabetes Association recommends an A1C goal of less than 7% for many nonpregnant adults, with the option of a less stringent goal of less than 8% for patients with short life expectancy, cardiovascular risk factors, or long-standing diabetes. Randomized trials in middle-aged patients with cardiovascular risk factors have shown no mortality benefit and in some cases increased mortality with more stringent A1C targets. Clinical recommendation Evidence rating References Metformin should be used as first-line therapy to reduce microvascular complications, assist in weight management, reduce the risk of cardiovascular events, and reduce the risk of mortality in patients with type 2 diabetes mell Continue reading >>
Tailoring Treatment To Reduce Disparities:
The American Diabetes Association (ADA) publishes the Standards of Medical Care in Diabetes annually, based on the latest medical research. The following narrative provides a summary of the 2017 updated recommendations that have been developed for clinical practice. The ADA guidelines are not intended to aid or preclude clinical judgment. The full guidelines can be accessed at ADA’s Diabetes Pro website. Tailoring Treatment to Reduce Disparities: Updated guidelines focus on improving outcomes and reducing disparities in populations with diabetes such as: Ethnic/Cultural/Sex/Socioeconomic Differences and Disparities: Provide structured interventions that are tailored to ethnic populations and integrate culture, language, religion, and literacy skills. Food Insecurity: Evaluate hyperglycemia and hypoglycemia in the context of food insecurity (FI), which is defined as the unreliable availability of nutritious food. Recognize that homelessness and poor literacy and numeracy often occur with FI. Propose solutions and resources accordingly. Comprehensive Medical Evaluation and Assessment of Comorbidities: The clinical evaluation should include conversation about lifestyle modifications and healthy living. PAs should address barriers including patient factors (e.g., remembering to obtain or take medications, fears, depression, and health beliefs), medication factors (e.g., complex directions, cost) and system factors (e.g., inadequate follow up). Simplifying treatment regimens may improve adherence. This section highlights the elements of a patient-centered comprehensive medical exam, including the importance of assessing comorbidities such as: Cognitive Dysfunction: Tailor glycemic therapy to avoid significant hypoglycemia. Cardiovascular benefits of statin therapy outweigh Continue reading >>
- Major Study Confirms Racial Disparities Related to Key Diabetes Indicator, Hemoglobin A1c
- Disparities in Diabetes Deaths Among Children and Adolescents United States, 20002014
- Relative effectiveness of insulin pump treatment over multiple daily injections and structured education during flexible intensive insulin treatment for type 1 diabetes: cluster randomised trial (REPOSE)
Experts Recommend Two-pronged Approach To Treating Prediabetes
According to the most recent data compiled by the CDC, 57 million U.S. adults have prediabetes, a figure that has reached pandemic levels. “In an ideal world, you want to diagnose high-risk people early in order to prevent progression to full-blown diabetes and its associated complications,” Glenn Matfin, MD, clinical associate professor at New York University and senior staff physician at the Joslin Diabetes Center, told Endocrine Today. Whether prediabetes progresses to diabetes depends on a number of variable factors, including lifestyle changes, genetics and treatment practices, which have some physicians supporting the use of medication and others vehemently against it. “We draw lines in order to differentiate between normal glucose tolerance, prediabetes and diabetes, but it is an interlinked, continuous chain,” Matfin said. “The clock is ticking, and the health risks rise significantly as prediabetes goes untreated.” To examine the current state of prediabetes treatment, Endocrine Today spoke with a number of experts to best understand how lifestyle and pharmacological approaches should be utilized to reverse glucose functions to normal levels. The issue is also examined from a financial aspect, as the ability to keep patients with prediabetes from turning into patients with diabetes translates into hundreds of millions of dollars saved in health care costs. Ralph DeFronzo, MD, and diabetes experts discuss preferred therapeutic approaches for people with prediabetes. Perhaps due to its subtle set of symptoms, the identification and diagnosis of patients with prediabetes has proved to be a challenge. Research has shown that although 30% of the U.S. population had prediabetes in 2005 to 2006, only 7.3% were aware that they had it. A consensus from diabe Continue reading >>
Therapeutic Use Of Metformin In Prediabetes And Diabetes Prevention
People with elevated, non-diabetic, levels of blood glucose are at risk of progressing to clinical type 2 diabetes and are commonly termed ‘prediabetic’. The term prediabetes usually refers to high–normal fasting plasma glucose (impaired fasting glucose) and/or plasma glucose 2 h following a 75 g oral glucose tolerance test (impaired glucose tolerance). Current US guidelines consider high–normal HbA1c to also represent a prediabetic state. Individuals with prediabetic levels of dysglycaemia are already at elevated risk of damage to the microvasculature and macrovasculature, resembling the long-term complications of diabetes. Halting or reversing the progressive decline in insulin sensitivity and β-cell function holds the key to achieving prevention of type 2 diabetes in at-risk subjects. Lifestyle interventions aimed at inducing weight loss, pharmacologic treatments (metformin, thiazolidinediones, acarbose, basal insulin and drugs for weight loss) and bariatric surgery have all been shown to reduce the risk of progression to type 2 diabetes in prediabetic subjects. However, lifestyle interventions are difficult for patients to maintain and the weight loss achieved tends to be regained over time. Metformin enhances the action of insulin in liver and skeletal muscle, and its efficacy for delaying or preventing the onset of diabetes has been proven in large, well-designed, randomised trials, such as the Diabetes Prevention Program and other studies. Decades of clinical use have demonstrated that metformin is generally well-tolerated and safe. We have reviewed in detail the evidence base supporting the therapeutic use of metformin for diabetes prevention. Notes Ulrike Hostalek and Steven Hildemann are employees of Merck KGaA, a pharmaceutical sponsor of several for Continue reading >>
Prediabetes - Treatment Overview
Your treatment for prediabetes will focus on losing weight, eating healthy foods, and getting active. This is your chance to reverse prediabetes so it doesn't turn into type 2 diabetes. Doing these things will also help you avoid other health problems, such as heart disease and stroke, that are linked to diabetes. You may also need to take diabetes medicine along with doing these things. Most people who have prediabetes are overweight and have a body mass index (BMI) of 25 or higher. To find out your BMI, use the Interactive Tool: Is Your BMI Increasing Your Health Risks? If you have a BMI of 25 or higher, try to lose 5% to 10% of your body weight. For example, if you weigh 200 pounds, aim to lose 10 to 20 pounds. A healthy weight helps your body use insulin the way it should. Losing weight can also lower insulin resistance in people who have prediabetes. The more you lose, the more you benefit, as long as you do it in a healthy way. How you do it is up to you. One way to start is by making healthy eating changes that you can keep doing over time. Try reducing the number of calories you eat and drink and adding more activity to your day. For help, see the topic Weight Management. One Man's Story: Jerry, 54 Jerry signed up for a weight-loss program and started a daily food diary to track what and when he ate. He added walks around the neighborhood and visits to the gym to his routine. In 7 months, he dropped 25 pounds-about 10% of his body weight. "It hasn't been easy. I've had some ups and downs, especially over the holidays. Hey, I love to eat. Sometimes it's hard to stay focused. But tracking what, when, and why I eat helps me to eat less."-Jerry Eating a balanced diet is one of the best things you can do for yourself and for your health. Try to: Limit the amount of u Continue reading >>
Aace: New Recommendations For Treatment Of Prediabetes
Home / Conditions / Prediabetes / AACE: New Recommendations for Treatment of Prediabetes AACE: New Recommendations for Treatment of Prediabetes New recommendations include: specific instructions for lifestyle intervention, and that pharmacotherapy be started at an A1c of six percent. It is estimated that there will be 418 million people worldwide with prediabetes by 2025. Clinical recommendations for the treatment of prediabetes were issued at the American Association of Clinical Endocrinologists 18th Annual Meeting and Clinical Congress in Houston. The consensus statement Diagnosis and Management of Prediabetes in the Continuum of Hyperglycemia: When do the Risks of Diabetes Begin? includes specific recommendations for lifestyle and pharmaceutical intervention where appropriate. The statement is the result of a prediabetes consensus conference held last July in Washington, D.C. There, 23 international experts in diabetes and metabolic disorders reviewed scientific data on prediabetes. Task force member, Yehuda Handelsman, MD, stated that, The issuing of the consensus statement today reflects our important focus on the need to manage the patient with prediabetes. Prediabetes is defined as impaired fasting glucose (100 mg/dL to 125 mg/dL), impaired glucose tolerance (140 mg/dL to 199mg/dL) or both. It is estimated that 314 million people worldwide have prediabetes, and that number is projected to be 418 million in 2025. Handelsman, treasurer of AACE and medical director of the Metabolic Institute of America stated that, lately, the numbers have become much more apparent, with sixteen percent of adolescents having diabetes and that is a huge number. Intensive lifestyle intervention remains the cornerstone of prevention. The task force recommended several lifestyle modifi Continue reading >>
