Birth Health Disease Death Traditional Model of Health and Disease
Optimal Symptoms Onset of Death Health Disease -- Functional Illness -- Full Spectrum of Health & Disease
Normal Impaired Glucose Diabetes Death Glucose Full Spectrum of Glucose Metabolism
Ruderman NB, Schneider SH, Berchtold P The “metabolically-obese,” normal-weight individual American Journal of Clinical Nutrition (1981;34: 1617-1621)
J Diabetes Complications 2001 Jan-Feb;15(1):34-7 Impaired glucose tolerance is a more advanced stage of alteration in the glucose metabolism than impaired fasting glucose. Guerrero-Romero F, Rodriguez-Moran M. This study demonstrates that subjects with IFG show hyperinsulinemia whereas those with IGT have low insulin secretion in response to oral load glucose, suggesting that IFG and IGT correspond to different stages of impaired glucose metabolism.
Blood Tests for Blood Sugar Baseline Category Cutoff Values, FPG/2hPG, mg/dL (mmol/L) ADA NFG: <110 (6.1) IFG: 110-126 (6.1-7.0) WHO NGT:<126 (7.0)/<140 (7.8) IGT: <126 (7.0)/140-200 (7.8-11.1)
Some Risk Factors Associated with Impaired Glucose Metabolism Waist-to-hip ratio BMI Systolic & diastolic BP Fasting insulin 2-hour insulin Fasting triglycerides HDL cholesterol
The Waist-to-Hip Ratio Reflects all-cause mortality including that from cardiovascular and non-cardiovascular diseases. Specifically reflects impaired glucose metabolism. Measure: –circumference of the waist at the umbilicus, –divided by the hip circumference. –Android body type = increased risk: Men: > 0.9 inches Women: > 0.8 inches
Ann Intern Med 1998 Apr 1;128(7):524-33 Metabolic risk factors worsen continuously across the spectrum of nondiabetic glucose tolerance The Framingham Offspring Study Meigs JB, Nathan DM, Wilson PW, Cupples LA, Singer DE “...our data reinforce the concept that asymptomatic glucose intolerance is not a benign metabolic condition.”
Caring for Patients with Impaired Glucose Metabolism Assessment Treatment Lifestyle
Assessment Poor concentration or sleepiness after meals Intestinal gas or bloating after meals Polycystic ovary syndrome Frequent hungry Increasing abdominal fat or facial fat (especially cheeks) Chronic fatigue
Assessment Insomnia or sleep apnea Waist size increasing with age Low protein intake Personal or family history: diabetes, kidney or gall stones, gout, high blood pressure, high cholesterol/low HDL, high triglycerides, heart disease or stroke, breast cancer.
Assessment Blood, saliva and others lab test as needed (including glycated hemoglobin) Physical exam, including neurological AK evaluation
Outcome of Patients with Impaired Glucose Metabolism Total Population of 145 subjects with IGT 44% became diabetic 22% remained impaired 34% returned to normal glucose metabolism Weyer et al. (2001)