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Screening for Prediabetes

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

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Screening for Prediabetes

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  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 6th 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 140-199 mg/dl IFG: FPG result of 100-125 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. 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. * Lifestyle modification= 150 min exercise per wk and 5% to 7% reduction in body weight. Rosiglitazone and lifestyle modification have proven to be the most effective at preventing progression from prediabetes to diabetes and increasing reversion to normoglycemia. 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. Prediabetes has no symptoms so patients cannot know if they have it unless their health care provider decides to screen them! 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

  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.

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