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Metformin Pre Diabetes Guidelines

Prediabetes: What Can Doctors Call It?

Prediabetes: What Can Doctors Call It?

Prediabetes, intermediate hyperglycemia, insulin resistance, or abnormal blood glucose. No matter what you call it, the glucometabolic state that may precede diabetes is considered one that warrants preventive action. Internists know to screen patients for diabetes, but even if blood glucose levels fall short, they may still need to provide a diagnosis and treatment. Patients with higher-than-normal blood glucose levels are at increased risk for developing type 2 diabetes, cardiovascular disease, and stroke, according to the CDC. By the agency's estimates, 86 million U.S. adults have prediabetes, and 90% of them don't know it. This is not because nine out of 10 people aren't being screened, said Tannaz Moin, MD, MBA, MSHS, an assistant professor of medicine at the David Geffen School of Medicine at the University of California, Los Angeles. “People are being screened because doctors are thinking about diabetes, and we have pretty standardized guidelines on who should be screened. … But results in the prediabetes range is where I think there's confusion among patients and also clinicians,” she said. The confusion is understandable, as there have been questions about the diagnostic accuracy of the available screening tests, as well as about the evidence behind using an off-label drug to prevent diabetes. Some clinicians have even considered the term “prediabetes” to be a misnomer, as not all patients with elevated blood glucose levels go on to develop diabetes. Regardless of what term is used for the preceding condition, however, the goal of preventing diabetes remains worthwhile. Several experts offered their evidence-based tips for managing screening, diagnosis, and treatment. Defining prediabetes As of 2015, the U.S. Preventive Services Task Force (USPSTF) re Continue reading >>

Management Of Prediabetes

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 >>

Metformin For Prediabetes

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 >>

Pre-diabetes: Risk Factor Management

Pre-diabetes: Risk Factor Management

Pre-diabetes: Risk factor management November 2016 Key Points: People with pre-diabetes are at increased risk of developing diabetes. Given the disproportionately high prevalence of diabetes and pre-diabetes in MÄori, Pacific and Indo-Asian people, these groups are especially at risk of developing type 2 diabetes and associated comorbidities. Pre-diabetes should be managed along with associated cardiovascular risk factors eg, tobacco smoking, high blood pressure, high cholesterol. Lifestyle interventions can delay or reduce progression to type 2 diabetes, and possibly reduce long-term morbidity and mortality. A range of interventions are effective; the choice will depend on individual/ whÄnau/family preferences and community resources. Many interventions can provide better results than usual care, but ongoing support and follow up are required to enable behaviour change. Efficacy increases with multiple behaviour changes, with weight loss being dominant. For overweight or obese people, aim for a long-term loss of at least five percent of initial weight. Introduction Diabetes is associated with significant morbidity and mortality from both micro- and macrovascular disease, and increased health and societal costs. The prevalence of diabetes is higher in MÄori, Pacific and Indo-Asian populations and amongst those living in lower socio-economic areas. Prevention, early identification and effective management of diabetes and associated cardiovascular and metabolic risk factors are key to reducing the population morbidity and mortality burden. According to the virtual diabetes register (VDR , Ministry of Health), an estimated 260,000 New Zealanders had diabetes at end 2015. In the 2008/09 New Zealand Adult Nutrition Survey, an estimated seven percent of New Zealand adults Continue reading >>

Metformin For Prediabetes

Metformin For Prediabetes

This Issue The oral biguanide metformin (Glucophage, and others) is generally the drug of choice for initial treatment of type 2 diabetes. It has also been used to prevent or at least delay the onset of diabetes in patients considered to be at high risk for the disease. Recent guidelines recommend considering use of metformin in patients with prediabetes (fasting plasma glucose 100-125 mg/dL, 2-hr post-load glucose 140-199 mg/dL, or A1C 5.7-6.4%), especially in those who are <60 years old, have a BMI >35 kg/m2, or have a history of gestational diabetes.1 Metformin has not been approved for such use by the FDA. Continue reading >>

Take Metformin If You Have Prediabetes

Take Metformin If You Have Prediabetes

Do you have prediabetes? You might be able to ward it off with the help of one of the diabetes drugs. Metformin might stop you from getting diabetes and could also help you in other ways. But persuading your doctor to prescribe it could be a challenge. The biggest and perhaps the best study of people who have prediabetes showed that taking metformin cuts the risk of diabetes by 31 percent. While this was less than the reduction of 58 percent that the “lifestyle intervention” provided, in real life we usually aren’t able to get that much guidance from our medical team. By “lifestyle intervention” the researchers meant being in a program that provided information, guidance, and support to help participants lose 7 percent or more of their weight and to get moderately intense physical activity — like brisk walking — for at least 150 minutes a week. But without that guidance, it typically takes a long time to help, and in fact it most people just don’t do it. Who Metformin Helps Most The study showed that metformin helped the most among younger people, and with people who had a high body mass index (BMI) or a high fasting blood glucose level. It doesn’t help seniors much. But the biggest problem with metformin is to have your doctor prescribe it. Only 3.7 percent of insured adults who had a prediabetes diagnosis were taking it between 2010 and 2012, according to a study that the Annals of Internal Medicine published last year. This very low proportion is probably because the U.S. Food and Drug Administration hasn’t approved metformin — or any other drug — for prediabetes. While doctors are free to prescribe it “off label,” some of them are hesitant to do that. Some Side Effects Like any drugs, metformin sometimes has unwanted side effects. The mos Continue reading >>

Therapeutic Use Of Metformin In Prediabetes And Diabetes Prevention

Therapeutic Use Of Metformin In Prediabetes And Diabetes Prevention

Go to: Pathophysiology and Diagnosis of Prediabetes The defects in glucose metabolism that underlie type 2 diabetes begin many years before the diagnosis of diabetes is made [6, 7]. The development of insulin resistance, in which the action of insulin on glucose metabolism is blunted, occurs early in the pathogenesis of dysglycaemia. Increased secretion of insulin initially compensates for the presence of insulin resistance; however, a simultaneous and progressive loss of β-cell mass and β-cell function limits the ability of the pancreas to maintain euglycaemia by increasing insulin secretion [8]. The early manifestations of prediabetic dysglycaemia represent one or both of [9]: impaired glucose tolerance (IGT), in which postprandial glucose control is impaired but fasting plasma glucose (FPG) is normal; impaired fasting glucose (IFG), in which a chronic elevation of FPG occurs in the absence of a deterioration in postprandial glucose control. Table 1 shows the usually accepted diagnostic criteria for the diagnosis of prediabetes based on measurements of glycaemia [4, 8–10]. A simple blood test is sufficient to diagnose IFG, while a 75 g oral glucose tolerance test (OGTT) is required for the diagnosis of IGT. The originally used cutoff level for IFG (110 mg/dL [6.1 mmol/L]) was reduced to that shown in Table 1 (100 mg/dL [5.6 mmol/L]) by an Expert Committee of the American Diabetes Association in 2003, in order to equalise the prognostic impact of diagnosis of IFG or IGT, in terms of the future risk of diabetes in a subject with either condition [11]. It should be noted that the World Health Organization (WHO) diagnostic criteria for IFG retains the 110 mg/dL (6.1 mmol/L) cutoff value for diagnosing IFG [12]. Diagnostic criteria from the American Diabetes Associatio Continue reading >>

Jabfp | Mobile

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 >>

Prediabetes - Medications

Prediabetes - Medications

XIAFLEX® is a prescription medicine used to treat adults with Dupuytren's contracture when a "cord" can be felt. It is not known if XIAFLEX® is safe and effective in children under the age of 18. Do not receive XIAFLEX® if you have had an allergic reaction to collagenase clostridium histolyticum or any of the ingredients in XIAFLEX®, or to any other collagenase product. See the end of the Medication Guide for a complete list of ingredients in XIAFLEX®. XIAFLEX® can cause serious side effects, including: Tendon rupture or ligament damage. Receiving an injection of XIAFLEX® may cause damage to a tendon or ligament in your hand and cause it to break or weaken. This could require surgery to fix the damaged tendon or ligament. Call your healthcare provider right away if you have trouble bending your injected finger (towards the wrist) after the swelling goes down or you have problems using your treated hand after your follow-up visit Nerve injury or other serious injury of the hand. Call your healthcare provider right away if you get numbness, tingling, increased pain, or tears in the skin (laceration) in your treated finger or hand after your injection or after your follow-up visit Hypersensitivity reactions, including anaphylaxis. Severe allergic reactions can happen in people who receive XIAFLEX® because it contains foreign proteins. Call your healthcare provider right away if you have any of these symptoms of an allergic reaction after an injection of XIAFLEX®: hives swollen face breathing trouble chest pain low blood pressure dizziness or fainting Increased chance of bleeding. Bleeding or bruising at the injection site can happen in people who receive XIAFLEX®. Talk to your healthcare provider if you have a problem with your blood clotting. XIAFLEX® may not b Continue reading >>

New Drug Approved By Nice For Prediabetes

New Drug Approved By Nice For Prediabetes

Diabetes Forum The Global Diabetes Community Find support, ask questions and share your experiences. Join the community New Drug Approved by NICE for Prediabetes Discussion in ' Prediabetes ' started by AndBreathe , Jun 1, 2017 . I don't know if anyone subscribes to MIMS, but this appeared in their reduglar update today. MIMS is a free subscription. First drug approved for diabetes prevention Glucophage SR (sustained-release metformin) has gained new approval for use in preventing diabetes. Glucophage SR can now be used alongside lifestyle measures to reduce the risk or delay the onset of overt type II diabetes in overweight people with non-diabetic hyperglycaemia (impaired glucose tolerance, impaired fasting glucose or increased HbA1c) who are at high risk of progression to diabetes. NICE defines impaired glucose tolerance as a fasting plasma glucose less than 7.0mmol/L and a 2-hour venous plasma glucose (after ingestion of 75g oral glucose load) of 7.811.1mmol/L. Impaired fasting glucose is a level of 6.16.9mmol/L and HbA1c is considered increased at a level of 4247mmol/mol (6.06.4%). Glucophage SR can be used when intensive lifestyle changes for 3 to 6 months have failed to stop progression to type II diabetes. Lifestyle modifications should be continued when metformin is initiated, unless the patient is unable to do so because of medical reasons. Treatment with Glucophage SR must be based on a risk score incorporating measures of glycaemic control and including evidence of high cardiovascular risk. NICE public health guidance recommends standard-release metformin as an option to support lifestyle change for people at high risk of type II diabetes whose HbA1c or fasting plasma glucose has deteriorated despite participation in an intensive lifestyle-change programme Continue reading >>

Experts Recommend Two-pronged Approach To Treating Prediabetes

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 >>

Approach To The Patient With Prediabetes

Approach To The Patient With Prediabetes

Med Star Clinical Research Center, Washington, D.C. 20003 Search for other works by this author on: Med Star Clinical Research Center, Washington, D.C. 20003 Address all correspondence and requests for reprints to: Robert Ratner, Med Star Clinical Research Center, 650 Pennsylvania Avenue SE, Washington, DC 20003. Search for other works by this author on: The Journal of Clinical Endocrinology & Metabolism, Volume 93, Issue 9, 1 September 2008, Pages 32593265, Vanita R. Aroda, Robert Ratner; Approach to the Patient with Prediabetes, The Journal of Clinical Endocrinology & Metabolism, Volume 93, Issue 9, 1 September 2008, Pages 32593265, Prediabetes consists of impaired fasting glucose and/or impaired glucose tolerance and is a significant risk factor for the development of type 2 diabetes, microvascular, and macrovascular disease. The values used to define prediabetes are arbitrary, because prediabetes represents an intermediary category along the continuum from normal glucose levels and tolerance to overt hyperglycemia. The progression from prediabetes to type 2 diabetes occurs over many years, strong evidence to support intervention to delay the progression from prediabetes to diabetes. Large, randomized prospective studies with lifestyle intervention and/or various modes of pharmacotherapy have demonstrated successful delay of diabetes. Several issues in the management of prediabetes remain controversial, such as the role of pharmacotherapy and when to escalate treatment. This article will review some of the issues surrounding the identification and treatment of prediabetes, with an interpretation of the available data to help guide management. A 46-yr-old female is referred to you for an abnormal fasting glucose of 115 mg/dl (6.4 mmol/liter). She has no significant p Continue reading >>

Diagnosis

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 >>

Metformin For Prediabetes: Success

Metformin For Prediabetes: Success

In a controlled trial, 600 overweight and obese people with prediabetes were given metformin. Metformin is in the biguanide class. It works by decreasing glucose production by the liver and increasing the insulin sensitivity of body tissues. It also can possibly help patients to lose weight, and possibly prevent some forms of cancer. Metformin was discovered in 1922. Study in humans began in the 1950s, by French physician Jean Sterne. It was introduced as a medication in France in 1957 and the United States in 1995. It is on the World Health Organization’s List of Essential Medicines, the most important medications needed in a basic healthcare system. Metformin is believed to be the most widely used medication for diabetes, which is taken by mouth. It is available as a generic medication. The wholesale price in In the United States costs $3 to $25 USD per month. For those patients who are under age 60 with prediabetes, the ADA has recommended metformin for those with a BMI over 34 and for women with gestational diabetes in the past. But, for others, especially for those over the age of 60, and even teenagers who rarely are treated with metformin, the study found that just 3.7% of those with prediabetes were actually prescribed metformin, over a 3-year period. Since metformin has been around since 1950 and even longer overseas and has even been shown to possibly prevent certain kinds of cancer, why should it not be standard procedure to provide all those with prediabetes the option to be treated with metformin? With the cost for the 29 million patients with diabetes at over 300 billion dollars, should we be asking the question: with more than 90 million people in the U.S. with prediabetes — a number that’s still growing — why doesn’t the FDA or the ADA recommen Continue reading >>

Prediabetes

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 >>

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