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Prediabetes Diagnosis Guidelines Changed from 110 to 100mg/dL

Posted: Monday, November 17, 2003

October 25th: An international expert committee on the diagnosis and classification of diabetes mellitus has published revised guidelines, which incorporate new data since the last report of 1997, in the November issue of Diabetes Care.

"Lowering the threshold should help pick up more people who are at increased risk for developing diabetes," Committee Chair Saul Genuth, MD, from Case Western Reserve University in Cleveland, Ohio, says in a news release. "What's important about that is that we now know — through studies such as the Diabetes Prevention Program (DPP) and the Finnish Diabetes Study — that we can prevent or delay the progression to diabetes from impaired glucose tolerance, the original component with the term pre-diabetes, through intensive lifestyle treatment, such as exercise and diet therapy. We hope, but don't yet know, that intervening earlier might also reduce the risk of diabetic complications, including cardiovascular complications."

Modest weight loss and regular exercise can prevent or delay the development of type 2 diabetes by up to 58%, based on results of the DPP and other studies.

Criteria for the diagnosis of diabetes remain unchanged, and the committee recommended against using the HbA1C as a routine diagnostic test for diabetes. Although clinical evidence is currently inadequate for superiority of either the fasting plasma glucose (FPG) test or the oral glucose tolerance test (OGTT), the committee prefers the FPG because of its greater convenience and lower cost.

The American Diabetes Association (ADA) recommends that individuals aged 45 years or older, especially those who are overweight or obese, be screened for diabetes/prediabetes and retested every three years if normal. Individuals at increased risk because of obesity, family history, gestational diabetes, or other recognized risk factors for diabetes should be considered for screening every few years, according to Dr. Genuth.

Unanswered questions mandating further research include defining the best approach to diabetes detection, understanding the pathophysiology and risks of IPG and glucose tolerance, and determining to what extent cardiovascular risk can be lowered by starting treatment of glycemia earlier.

"The answers to these and other questions will necessitate regular surveillance and reconsideration of new data that may lead to appropriate revisions to the diagnostic and classification criteria for diabetes over time," the authors write.

Source: Diabetes In Control.com