Using a Quantitative Measure of Diabetes Risk in Clinical Practice to Target and Maximize Diabetes Prevention Interventions

Abstract

A n estimated 79 million American adults are at risk for developing type 2 diabetes, based on a condition referred to as prediabetes.1 Although there is currently no cure for type 2 diabetes, studies have definitively shown that the progression from prediabetes to diabetes can be delayed or prevented through lifestyle modifications and pharmacological treatment.2–4 Unfortunately, the vast majority of people with prediabetes are undiagnosed. Indeed, a recent study by Geiss et al.5 found that < 8% of U.S. adults with prediabetes are aware of their condition. Given the growing diabetes epidemic and the alarming prevalence of unawareness among those at risk for developing this disease, the American Diabetes Association (ADA) recommends screening of all patients who are at risk for prediabetes or who may have undiagnosed diabetes (Table 1).6 Individuals meeting the criteria in Table 1 should have their glycemic status assessed by fasting plasma glucose (FPG), oral glucose tolerance test (OGTT), or A1C. As shown in Table 2, the diagnosis of prediabetes is based on glucose or A1C values that are higher than normal but not at levels diagnostic of diabetes.6 According to ADA recommendations, individuals who are identified as having prediabetes should be referred to an ongoing support program that targets weight loss and increased physical activity, and these programs should be covered by third-party payers.6 The ADA further recommends that treatment with metformin be considered for at-risk patients who have a BMI ≥ 35 kg/m2, are < 60 years of age, and/or are women with prior gestational diabetes.6 View this table: Table 1. Criteria for Testing Adult Patients for Prediabetes or Diabetes6 Given the significant clinical and economic costs associated with type 2 diabetes, it is crucial that diabetes prevention be a priority for the health care …