prediabetes
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Introduction
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
- fasting plasma glucose:* 100-125 mg/dL
- oral glucose tolerance test (2 hour): 140-199 mg/dL
- predicts progression to diabetes mellitus type 2
- hemoglobin A1c of 5.7-6.4%[5]
- repeat screening for diabetes every 1-2 years
* previously 110 mg/dL
* if fasting plasma glucose > 125 mg/dL, repeat fasting plasma glucose
- two measurements of fasting plasma glucose > 125 mg/dL makes diagnosis of diabetes mellitus regardless of hemoglobin A1c (6.0% in example)[4]
Complications
- most of these persons will develop diabetes within 10 years
- higher risk of heart disease & stroke (RR = 1.2)[7][15]
- increase risk of aortic stenosis[22]
- 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
- disease interaction(s) of prediabetes with Parkinson's disease.
- disease interaction(s) of obesity with prediabetes
Management
- life-style changes prevent progress to type 2 diabetes (41% vs 58%)[4]
- intensive lifestyle intervention reduces progression to type 2 diabetes by 58%[24]
- see prevention of diabetes
- metformin reduces progression to type 2 diabetes by 31% vs placebo[24]
- after 21 years of followup, mortality similar in patients with prediabetes randomized to lifestyle intervention, metformin, or placebo[19]
- patients with prediabetes who achieve normal glucose regulation, even transiently, are less likely to develop diabetes [6]2) modest weight loss
- modest aerobic exercise
- 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]
- 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]
- orlistat, acabose or voglibose, or thiazolidinedione also shown to delay onset of diabetes by up to 3 years[4]
- lorcaserin (Belviq) may promote weight loss & slow progression to type 2 diabetes & promote remission of type 2 diabetes[16]
- 100 mg aspirin daily results in a 50% reduction in the incidence of new-onset type-2 diabetes in elderly with prediabetes, but with an increased risk of GI bleeding[26]
- vitamin D of no benefit in preventing progression of prediabetes to type 2 diabetes
* preferred over diet & lifestyle changes[4], orlistat, acarbose or thiazolidinediones (no references cited)
More general terms
Additional terms
- diabetes mellitus
- impaired fasting glucose
- impaired glucose tolerance
- risk factors for diabetes mellitus type 2 & risk factor reduction
References
- ↑ Prescriber's Letter 9(4):19 2002
- ↑ Prescriber's Letter 11(1):1 2004 Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=200106&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ Prescriber's Letter 15(9): 2008 Diagnosis and Treatment of Pre-diabetes Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=240906&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 4.0 4.1 4.2 4.3 4.4 4.5 4.6 Medical Knowledge Self Assessment Program (MKSAP) 14, 16, 17, 18, 19. American College of Physicians, Philadelphia 2006, 2012, 2015, 2018, 2022.
Medical Knowledge Self Assessment Program (MKSAP) 20 American College of Physicians, Philadelphia 2025 - ↑ 5.0 5.1 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; <PubMed> PMID: https://pubmed.ncbi.nlm.nih.gov/21705064 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60472-8/fulltext
- ↑ 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 <PubMed> PMID: https://pubmed.ncbi.nlm.nih.gov/22683134 <Internet> 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 <PubMed> PMID: https://pubmed.ncbi.nlm.nih.gov/22683127 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60828-9/fulltext - ↑ 7.0 7.1 Lee M et al. Effect of pre-diabetes on future risk of stroke: Meta-analysis. BMJ 2012 Jun 7; 344:e3564. PMID: https://pubmed.ncbi.nlm.nih.gov/22677795
- ↑ 8.0 8.1 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 <PubMed> PMID: https://pubmed.ncbi.nlm.nih.gov/23761134 <Internet> http://care.diabetesjournals.org/content/early/2013/06/03/dc13-0084.abstract
- ↑ 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: https://pubmed.ncbi.nlm.nih.gov/25894024
- ↑ Sussman JB et al Improving diabetes prevention with benefit based tailored treatment: risk based reanalysis of Diabetes Prevention Program. BMJ 2015;350:h454 <PubMed> PMID: https://pubmed.ncbi.nlm.nih.gov/25697494 <Internet> http://www.bmj.com/content/350/bmj.h454
- ↑ 11.0 11.1 11.2 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 <PubMed> PMID: https://pubmed.ncbi.nlm.nih.gov/25665810 <Internet> http://care.diabetesjournals.org/content/38/5/793 - ↑ New AMA, CDC Initiative Aims to "Prevent Diabetes STAT" http://www.cdc.gov/media/releases/2015/p0311-diabetes-stat.html
- ↑ 13.0 13.1 Menke A et al Prevalence of and Trends in Diabetes Among Adults in the United States, 1988=2012. JAMA. 2015;314(10):1021-1029 <PubMed> PMID: https://pubmed.ncbi.nlm.nih.gov/26348752 <Internet> 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. <PubMed> PMID: https://pubmed.ncbi.nlm.nih.gov/26348749 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=2434665 - ↑ 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: https://pubmed.ncbi.nlm.nih.gov/26829443
- ↑ 15.0 15.1 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 <PubMed> PMID: https://pubmed.ncbi.nlm.nih.gov/27881363 Free full text <Internet> http://www.bmj.com/content/355/bmj.i5953
- ↑ 16.0 16.1 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: https://pubmed.ncbi.nlm.nih.gov/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: https://pubmed.ncbi.nlm.nih.gov/30293772 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32460-7/fulltext - ↑ 17.0 17.1 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 <PubMed> PMID: https://pubmed.ncbi.nlm.nih.gov/31000505 <Internet> http://care.diabetesjournals.org/content/42/5/731
- ↑ 18.0 18.1 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: https://pubmed.ncbi.nlm.nih.gov/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: https://pubmed.ncbi.nlm.nih.gov/33555307 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2775591 - ↑ 19.0 19.1 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: https://pubmed.ncbi.nlm.nih.gov/34697033 PMCID: PMC8669534 (available on 2022-12-01) https://diabetesjournals.org/care/article/44/12/2775/138471/Effect-of-Metformin-and-Lifestyle-Interventions-on
- ↑ 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: https://pubmed.ncbi.nlm.nih.gov/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: https://pubmed.ncbi.nlm.nih.gov/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: https://pubmed.ncbi.nlm.nih.gov/33298414 - ↑ 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:http://dx.doi.org/ 10.1056/NEJMoa012512. PMID: https://pubmed.ncbi.nlm.nih.gov/11832527 PMCID: PMC1370926 Free PMC article. Clinical Trial. https://www.nejm.org/doi/pdf/10.1056/NEJMoa012512 - ↑ 22.0 22.1 Sohlman M, Jauhiainen R, Vangipurapu J et al Biomarkers reflecting insulin resistance increase the risk of aortic stenosis in a population-based study of 10,144 Finnish men. Ann Med. 2024 Dec;56(1):2419996. PMID: https://pubmed.ncbi.nlm.nih.gov/39593205 Free article. https://www.tandfonline.com/doi/full/10.1080/07853890.2024.2419996
- ↑ American Diabetes Association Professional Practice Committee. 3. Prevention or delay of diabetes and associated comorbidities: Standards of Care in Diabetes - 2024. Diabetes Care. 2024;47:S43-S51. PMID: https://pubmed.ncbi.nlm.nih.gov/38078581
- ↑ 24.0 24.1 24.2 Knowler WC, Doherty L, Edelstein SL, et al. Long-term effects and effect heterogeneity of lifestyle and metformin interventions on type 2 diabetes incidence over 21 years in the US Diabetes Prevention Program randomised clinical trial. Lancet Diabetes Endocrinol. 2025 Apr 28:S2213-8587(25)00022-1 PMID: https://pubmed.ncbi.nlm.nih.gov/40311647
- ↑ 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 - ↑ 26.0 26.1 Lembo M, Trimarco V, Pacella D et al Daily low dose aspirin halves incident type 2 diabetes in elderly subjects with prediabetes: a five-year longitudinal cohort study in a real-word population. Cardiovascular Diabetology. 2025 Jun 18;24(1):259 PMID: https://pubmed.ncbi.nlm.nih.gov/40533771 PMCID: PMC12175347 Free PMC article. https://cardiab.biomedcentral.com/articles/10.1186/s12933-025-02802-9
- ↑ Insulin Resistance and Pre-Diabetes http://diabetes.niddk.nih.gov/dm/pubs/insulinresistance/index.htm