Prediabetes NOT IN TAV

Question 1

Risk Factors for PREDIABETES

Answer 1

(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 2

Essentials of the diagnosis for what issue?
(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)

Answer 2

PREDIABETES

Question 3

S/S of what issue?
Generally these patients are asymptomatic.
(a) Glucose elevations generally will not produce polyuria or polydipsia seen in Diabetes type 1 or 2
(b) this alone is not expected to produce new physical exam findings
(c) It is postulated that early sensory nerve toxicity occurs in this (e.g. a presenting symptoms could be subtle lower extremity paresthesia)

Answer 3

PRE-DIABETES

Question 4

Tx for Prediabetes

Answer 4

(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 5

Complications of prediabetes

Answer 5

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

Question 6

Differential Diagnosis for PREDIABETES

Answer 6

(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