Prediabetes

00:00 Let's talk a little bit about prediabetes. Type 2 diabetes is usually preceded by prediabetes and this is characterized by a fasting blood glucose in the range of 100-125, a plasma glucose of 140-199 two hours after 75 gram oral glucose load, or a hemoglobin A1c that lies between the ranges of 5.7 and 6.4% as it did in outpatient. Lifestyle modifications are always the first line treatment for newly diagnosed type 2 diabetes. Alone or combined with therapeutic interventions, they prevent or delay the development of overt diabetes. They're also cost effective. Several randomized control trials provide evidence that diet changes, increased daily exercise, and weight loss of up to 5-7% of body mass decrease the risk of developing type 2 diabetes in persons with prediabetes in the range of 41-58%. Metformin reduces the risk of diabetes in patients with prediabetes but not as much as lifestyle modifications. The American Diabetes Association recommends metformin for patients with impaired glucose tolerance, impaired fasting glucose levels, and a hemoglobin A1c that ranges between 5.7% and 6.4%. This table compares some of the interventions that you might introduce in the management of a patient with prediabetes and also compares and contrasts the various effectiveness of these modalities. Starting with diet and exercise, we know that a 7% sustained weight loss plus 150 minutes of moderate exercise per week delays the onset of diabetes by up to 3 years. Likewise, the initiation of metformin has been shown to delay the onset of diabetes in those patients with prediabetes by up to 3 years as well. Bariatric surgery, which is a fairly drastic step, has clearly been shown to reduce the serum glucose levels in patients with morbid obesity. This particular procedure is recommended for those with body mass indices greater than 40 or morbid obese persons. In terms of other oral hypoglycemic agents; the lipase inhibitors, the thiazolidinediones, and the alpha-glucosidase inhibitors they have also been shown with consistent use to delay diabetes onset by up to 3 years.