The Medical clinics of North America
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Diabetes evolves through prediabetes, defined as impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT). Subjects with IFG/IGT have an increased risk of developing diabetes and a higher prevalence of cardiovascular disease than normoglycemic individuals. ⋯ Therefore, an absolute definition of prediabetes may underestimate the implications and vastness of this disorder. Research should focus on these aspects to minimize the risk of developing a preventable condition.
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A rational approach to diagnosing prediabetes is essential to identify those who would benefit from entering diabetes prevention programs. Impaired fasting glucose and impaired glucose tolerance are similar in relation to their ability to identify those at risk of diabetes or cardiovascular disease; however, because they identify different segments of the at-risk population, there is value in undertaking glucose tolerance testing to ensure that both conditions can be diagnosed. Simple noninvasive diabetes risk scores offer a valuable entry point in the diagnosis of prediabetes, enabling the identification of those who need blood testing.
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In the United States, the costs associated with diabetes mellitus are increasing. Although people with diabetes comprise less than 6% of the US population, approximately 1 in 5 health care dollars is spent caring for people with diabetes. Healthy lifestyle interventions for the general population and intensive lifestyle and medication interventions for high-risk individuals present opportunities for diabetes prevention. This article describes the costs associated with glucose intolerance and diabetes, the effect of glucose intolerance and diabetes on the quality of life, and the cost-effectiveness of screening and primary prevention interventions for diabetes prevention.
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A variety of definitions and diagnostic cutpoints have been promulgated for prediabetes without universal agreement. Professional organizations agree that current scientific evidence justifies intervention in high-risk populations for the delay or prevention of progression to diabetes. Lifestyle intervention is universally accepted as the primary intervention strategy. Secondary intervention is advocated in high-risk individuals or in the absence of a clinical response to lifestyle modification.
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Identifying individuals at increased risk of developing diabetes has assumed increasing importance with the expansion of the evidence from clinical trials on the prevention or delay of type 2 diabetes using lifestyle modification and medication. The epidemiology of prediabetes depends on the diagnostic method used. Glucose measures defining impaired glucose tolerance and impaired fasting glucose levels identify about 10% of the adults to have prediabetes, whereas glycated hemoglobin-based criteria identify a significantly lower proportion of the population. Increasingly, multifactorial risk tools are being used and cut-points set to identify approximately 15% of the population as being at high risk.