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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.

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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:

1 Screening for Prediabetes By: Sarah Rentz

2 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!!!

3 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

4 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!!!

5 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???

6 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!!!

7 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!

8 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.

9 Bibliography American Diabetes Association. Standards of Medical Care in Diabetes Diabetes Care 2006; 29(S1): S4-S42. Brown CD, Davis HT, Edinger MN, Fleming CM, Hull EL, Rohrscheib M. Clinical assessment of near-infrared spectroscopy for noninvasive diabetes screening. Diabetes Technology and Therapeutics 2005; 7(3); Centers for Disease Control. National Diabetes Fact Sheet, United States Available at: Accessed February 5, Cheng C, Kushner H, Falkner BE. The utility of fasting glucose for detection of prediabetes. Metabolism: Clinical and Experimental 2006; 55(4): Chiasson JL, Josse RG, Gomis R, Hanefeld M, Karasik A, Laakso M. Acarbose for prevention of type 2 diabetes mellitus: the STOP-NIDDM randomized trial. The Lancet 2002; 359: Davies MJ, Raymond NT, Day JL, Hales CN, Burden AC. Impaired glucose tolerance and fasting hyperglycaemia have different characteristics. Diabetic Medicine 2000; 17: 433–40. DECODE Study Group on behalf of the European Diabetes Epidemiology Group. Is fasting glucose sufficient to define diabetes? Epidemiological data from 20 European studies. Diabetologia 1999; 42: Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or Metformin. New England Journal of Medicine 2002; 346(6): Doi Y, Kiyohara Y, Kubo M, Ninomiya T, Wakugawa Y, Yonemoto K, et al. Elevated C-reactive protein is a predictor of the development of diabetes in a general Japanese population. Diabetes Care 2005; 25: DREAM Trial Investigators. Effect of Rosiglitazone on the frequency of diabetes in patients with impaired glucose tolerance or impaired fasting glucose: a randomized controlled trial. The Lancet 2006; 368: Edelstein SL, Knowler WC, Bain RP, Andres R, Barrett-Connor EL, Dowse GK, et al. Predictors of progression from impaired glucose tolerance to NIDDM: An analysis of six prospective studies. Diabetes 1997; 46: Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Follow-up report on the diagnosis of diabetes mellitus. Diabetes Care 2003; 26(11): Festa A, Hanley AJG, Tracy RP, Agostino RD Jr, Haffner SM. Inflammation in the prediabetic stat is related to increased insulin resistance rather than decreased insulin secretion. Circulation 2003; 108: Finnish Diabetes Prevention Study (DPS). Lifestyle intervention and 3 year results on diet and physical activity. Diabetes Care 2003; 26(12): Franciosi M, Berardis GD, Rossi MCE, Sacco M, Belfiglio M, Pellegrini F, et al. Use of the diabetes risk score for opportunistic screening of undiagnosed diabetes and impaired glucose tolerance: The IGLOO (Impaired Glucose Tolerance and Long-Term Observational) study. Diabetes Care 2005; 28: Gabir MM, Hanson RL, Dabelea D, Imperatore G, Roumain J, Bennet PH, et al. The 1997 American Diabetes Association and 1999 World Health Organization criteria for hyperglycemia in the diagnosis and prediction of diabetes. Diabetes Care 2000; 23: Hallsten K, Virtanen KA, Lonnqvist F, Sipila H, Oksanen A, Viljanen T, et al. Rosiglitazone but not Metformin enhances insulin and exercise stimulated skeletal muscle glucose uptake in patients with newly diagnosed type 2 diabetes. Diabetes 2002; 51: Hanefeld M, Koehler C, Henkel E, Fuecker K, Schaper F, Temelkova-Kurktschiev T. Post-challenge hyperglycemia relates more strongly than fasting hyperglycemia with carotid intima-media thickness: the RIAD Study, Risk Factors in Impaired Glucose Tolerance for Atherosclerosis and Diabetes. Diabetic Medicine 2000;17(12): Herman WH, Hoerger TJ, Brandle M, Hicks K, Sorensen S, Zhang P, et al. The cost effectiveness of lifestyle modification or Metformin in preventing type 2 diabetes in adults with impaired glucose tolerance. Annals of Internal Medicine 2005; 142: Irons BK, Mazzolini TA, Greene RS. Delaying the onset of type 2 diabetes mellitus in patients with prediabetes. Pharmacotherapy 2004; 24(3):

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