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Prediabetes

A condition in which blood glucose levels are elevated, but not yet within the diabetic range. Prediabetes is also known as impaired fasting glucose (IFG) or impaired glucose tolerance (IGT). The new term was inaugurated by the U.S. Department of Health and Human Services (HHS) and the American Diabetes Association (ADA) in March 2002 to promote public understanding of this increasingly widespread problem. According to HHS, nearly 57 million Americans have prediabetes. Studies have shown that most people with blood glucose levels in the prediabetes range go on to develop Type 2 diabetes within 10 years; the condition also raises the risk of having a heart attack or stroke by 50%. Prediabetes can be controlled, and in many cases even reversed, through lifestyle changes.

Prediabetes can be detected by either of the two standard tests currently used to diagnose diabetes. In the fasting plasma glucose test (FPG), a person fasts overnight and then has blood drawn for testing first thing in the morning, before he eats. Until recently, a normal fasting blood glucose level under 110 mg/dl was considered to be normal and fasting blood glucose in the range of 110 to 125 mg/dl indicated impaired fasting glucose (IFG), or prediabetes. In late 2003, an international expert panel recommended that the cutoff be lowered to 100 mg/dl, so now people with a fasting blood glucose level of 100 to 125 mg/dl are considered to have prediabetes. A fasting blood glucose level over 125 mg/dl indicates diabetes. (A second test must be done on a subsequent day to confirm a diagnosis of diabetes.)

In the oral glucose tolerance test (OGTT), a person’s blood glucose is tested once after an overnight fast and again two hours after he has consumed a special, glucose-rich drink. A normal blood glucose level two hours after the drink would be below 140 mg/dl; an elevated blood glucose level in the range of 140 to 199 mg/dl indicates impaired glucose tolerance, or prediabetes. A blood glucose level 200 mg/dl or higher two hours after the drink indicates diabetes. (Again, a second test must be done on a subsequent day to confirm diabetes.)

Who is at risk for prediabetes? An expert panel convened by HHS and the ADA recommends that physicians begin screening all overweight people (with a body-mass index of 25 or higher) age 45 and up for the condition. People under the age of 45 who are overweight should also be screened if they have one or more of the following risk factors for diabetes: high blood pressure, a family history of diabetes, low high-density lipoprotein (HDL, or “good”) cholesterol and high triglycerides, a history of gestational diabetes or giving birth to a baby over 9 pounds, or belonging to one of the racial or ethnic groups that is at increased risk for Type 2 diabetes (African-Americans, Native Americans, Asian Americans/Pacific Islanders, and Hispanic Americans/Latinos). If a person is tested for prediabetes and his results are within the normal range, the ADA recommends that he be retested every three years (unless his doctor recommends testing more frequently). If a person is diagnosed with prediabetes, he should be screened for Type 2 diabetes every one to two years.

Prediabetes can also affect children and adolescents. A study published in The New England Journal of Medicine in March 2002 found that 25% of obese children and 21% of obese adolescents tested had blood glucose levels within the prediabetes range. Currently, not much is known about how to prevent or delay the onset of Type 2 diabetes in children. The widespread screening of younger people for prediabetes, therefore, is not currently called for by major health organizations. However, in 2000, the American Academy of Pediatrics recommended diabetes testing for obese children who also have two or more of the additional risk factors for diabetes mentioned above.

In adults who have been diagnosed with prediabetes, lifestyle changes can delay or prevent the development of full-blown Type 2 diabetes. Results from the Diabetes Prevention Program, a study conducted by HHS and involving more than 3,000 participants, showed that a 5% to 7% weight loss lowered the incidence of Type 2 diabetes by 58%. The weight loss was achieved through dieting (cutting fat and calories) as well as exercising moderately (most participants chose walking) for at least 150 minutes a week. Use of the oral diabetes drug metformin (brand name Glucophage) also helped to delay the onset of diabetes in some study participants; however, it was not as effective as diet and exercise. Drug use as a treatment for prediabetes is not recommended at this time.

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