Screening for Prediabetes

2. Screening for Prediabetes Kelly Moore, MD, FAAP IHS Division of Diabetes Treatment & Prevention

3. Overview • Diagnosis of Prediabetes • Screening Strategies • Draft Core Elements for Screening • Grantee Panel Discussion • Questions/Discussion

4. Prediabetes • Definition • Individuals with abnormal glucose regulation intermediate between the normal state and the state of diabetes • Impaired Fasting Glucose (IFG) • Impaired Glucose Tolerance (IGT) • Importance of detection • Each year, 10-28 percent develop diabetes • Research: Lifestyle changes can reduce risk of developing diabetes

5. Prediabetes • Detection and treatment will also: • Identify undiagnosed diabetes in some individuals • Identify undiagnosed hypertension and undiagnosed dyslipidemias in some patients • Lay the groundwork forhealthy lifestyle changes

6. Stages in the natural history of diabetes Primary Prevention Secondary Prevention Tertiary Prevention

7. Diagnosis of Prediabetes • Classification and Tests • Impaired Fasting Glucose (IFG) • Fasting Blood Glucose (FBG) 100 – 125 • Impaired Glucose Tolerance (IGT) • 2 hour Oral Glucose Tolerance Test (OGTT) 140 - 199

8. Comparison of Test Results

9. Overlap of IGT and IFG IFG IGT Both

10. Screening for Prediabetes • Targeted vs. Universal Screening • Targeted Screening • more cost effective • Universal Screening not routinely recommended • Screen individuals 18 years and older with risk factors for Prediabetes or Metabolic Syndrome • Overweight, Obesity • Hypertension • Low HDL, high TG • Women with a history of GDM • Family history of diabetes

11. Screening for Prediabetes • In practice, several strategies: • Community settings • Strategies include: • Paper risk tests • Fingerstick glucose tests • Importance of Follow-up • Clinical settings • Random blood glucose • Fasting blood glucose • 2 hr Oral Glucose Tolerance Test

12. CGP Considerations • Eligibility for Intensive Activities • Prediabetes – IFG, IGT • Consistent with DPP, other studies • Metabolic Syndrome – may consider eligibility later in demonstration project • Screening Activities • Opportunity to see what works, lessons learned • Potential benefits for other Indian health programs

13. Core Element: Screening • Draft Protocol/Required Elements • Developed in context of: • IHS Prediabetes Guidelines • Informal grantee input at previous meetings • Discussion with technical experts • IHS DDTP recommendations • Target screening of individuals with risk factors • Possible Settings for Screening • Community • Clinical Setting

14. Core Element: Screening • Community Screening • Assessment of Risk • Paper Risk Test, AND • Fingerstick Glucose • If either positive • Refer to clinic • OGTT – results include both FBG and 2 hr value • FBG alone not enough – may miss some with undiagnosed diabetes • Possible evaluation activity • Compare use of paper risk test, fingerstick glucose, FBG, OGTT • May result in lessons learned for other Indian health programs

15. Core Element: Screening • Outcomes of screening • Normal results • Education on risks for diabetes • Prediabetes (IFG or IGT) • Recruit to enter Intensive Activities • Diabetes • Refer to clinic for further care

16. Next Steps • Draft protocol/required activities • Handout for binder • Discuss with team • Grantee panel discussion • Experience with screening for prediabetes • Questions/Discussion/Input • All grant programs