Presentation on theme: "Screening for Prediabetes By: Sarah Rentz. Diabetes type 2 is a growing concern in America today An estimated 7.0% of the American population have diabetes."— Presentation transcript:
Screening for Prediabetes By: Sarah Rentz
Diabetes type 2 is a growing concern in America today An estimated 7.0% of the American population have diabetes 1/3 of diabetics remain undiagnosed It is the 6 th leading cause of death in America 54 million Americans have prediabetes 1 in 3 children born today will develop diabetes Risk factors associated with diabetes are also growing: Obesity Sedentary Lifestyle High Cholesterol The number of people with diabetes is expected to double by the year 2025!!!
Current screening practices are not identifying enough of the population at risk for diabetes and prediabetes! The result of this is that patients are not receiving diagnosis until complications from hyperglycemia are evident. Many of these complications are irreversible but could have been prevented with early intervention. Macrovascular: cardiovascular disease Microvascular: nephropathy, retinopathy, and neuropathy Current Screening Tests approved by the ADA include: Casual Plasma Glucose Fasting Plasma Glucose Oral Glucose Tolerance Test
Prediabetes is IGT, IFG, or both and it represents the gray area between normoglycemia and diabetes. Screening Test Results Diabetes: Casual plasma glucose ≥ 200 mg/dl or OGTT result of ≥ 200 mg/dl or FPG result of ≥ 126 mg/dl IGT: OGTT result of mg/dl IFG: FPG result of mg/dl So why is it important to diagnose prediabetes??? It is a major risk factor for development of diabetes. Prediabetes is associated with an increased risk of cardiovascular disease. The greater the hyperglycemia the greater the organ damage. It is treatable!!!
Study and TreatmentNumber Needed to Treat DPP- Lifestyle Modification* 7 for 3 years Finnish DPS- Lifestyle Modification*22 for 1 year or 5 for 5 years DPP- Metoformin14 for 3 years STOP-NIDDM- Acarbose10 for 3.3 years DREAM- Rosiglitazone7 for 3 years The ADA recommends diet and exercise as treatment for prediabetes and does not at this time suggest drug therapy, however the results below are convincing. Rosiglitazone and lifestyle modification have proven to be the most effective at preventing progression from prediabetes to diabetes and increasing reversion to normoglycemia. * Lifestyle modification= 150 min exercise per wk and 5% to 7% reduction in body weight. So this is a treatable condition with screening options, what is the problem then???
The main problem with screening for prediabetes is that both screening tests are needed to detect all prediabetic patients, but both are not fully utilized. FPG test is the one used most often because: It is more convenient to the provider and patient It is less time consuming for the patient It is cheaper to run It has an increased patient compliance The OGTT is the only way to detect people with isolated IGT, so if this test is not used, a large subset of people who are at great risk for developing diabetes and cardiovascular disease are being missed. If only a FPG is performed, 31% of the cases of prediabetes could be missed!!!
The need for alternate screening tests for prediabetes is becoming more apparent. The ADA currently recommends prediabetes screening for everyone over 45 and those who are under 45 but are overweight and have another risk factor such as family history or high cholesterol. This could result in a lot of unnecessary testing due to the high number of negative results. Possible solutions: Risk assessment survey- increase chance for positive test result HbA1c- alternate or adjunct to OGTT CRP- adjunct to OGTT Scout- detects skin changes non invasively Prediabetes has no symptoms so patients cannot know if they have it unless their health care provider decides to screen them!
Conclusions and Take Home Points Worldwide prevalence of diabetes is over an estimated 170 million and growing. New research shows that the deadly complications of this disease can be prevented through lifestyle modification and/or drug therapy. The current screening practices are not identifying acceptable numbers of those with prediabetes and diabetes. Health care professionals need to be made aware of the critical need for detecting both IGT and IFG in addition to diabetes. More efficient screening guidelines and procedures need to be implemented so that we can detect more cases of prediabetes and start treatment earlier in efforts to delay and/or prevent diabetes in these patients.
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