PREDIABETES

Question 1

Essentials of the diagnosis of a patient with Prediabetes

Answer 1

(1) Impaired fasting glucose (100-125mg/dl)
(2) Borderline Hgb-A1C elevation (5.7-6.4%)
(3) 2 hour post-prandial glucose (140-199mg/dl)

Question 2

Pathogenesis of a patient with Prediabetes

Answer 2

(1) Insulin resistance (insulin receptors on muscle cells do not adequately respond)
(2) Insulin production is decreasing due to autoimmunity (Type 1 Diabetes) or
decreased insulin production (as can be seen late in the course of Type 2
Diabetes and referred to as “pancreatic burnout”)

Question 3

Risk Factors of a patient with Prediabetes

Answer 3

(1) Family History (1st degree relatives) / Genetic predisposition
(2) Obesity
(3) Diet
(4) Physical inactivity
(5) Race (African American, Latino, Native American, Asian American, Pacific
Islander)
(6) Women who delivered a baby weighing 9 lb. or greater or had previous diagnosis
of gestational diabetes

Question 4

Signs / Symptoms / Physical Exam of a patient with Prediabetes

Answer 4

(1) Generally these patients are asymptomatic.
(a) Glucose elevations generally will not produce polyuria or polydipsia seen in
Diabetes type 1 or 2
(b) Prediabetes alone is not expected to produce new physical exam findings
(c) It is postulated that early sensory nerve toxicity occurs in pre-diabetes (e.g. a
presenting symptom for pre-diabetes could be subtle lower extremity
paresthesia)

Question 5

Differential Diagnosis of a patient with Prediabetes

Answer 5

(1) Non-fasting serum glucose obtained (patients may forget to fast, inadvertently
add cream to coffee, eat calorie containing gum/ mints/candies, etc.).
(2) Well controlled Type 1 or 2 Diabetes (though history and medication
reconciliation should rule these out)
(3) Cushing syndrome (excess cortisol)
(4) Medications such as corticosteroids, antibiotics, beta-blockers, psychiatric
medications thiazide diuretics (HCTZ or Chlorthalidone).
(5) Hyperthyroidism

Question 6

Treatment of a patient with Prediabetes

Answer 6

(1) Weight loss if overweight/obese
(2) In obese patients there is evidence Metformin 850mg BID may lower risk of
developing Type 2 Diabetes by 30%. This is less effective in thin or elder
patients.
(3) Increased physical activity / exercise

Question 7

Complications of a patient with Prediabetes

Answer 7

(1) Progression to Type 2 Diabetes
(2) Increased cardiovascular / ischemic stroke risk
(3) Peripheral neuropathy