Prediabetes
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Prediabetes. Screening and Monitoring. Prediabetes. Epidemiologic evidence suggests that the complications of T2DM begin early in the progression from NGT to frank diabetes Prediabetes and diabetes are conditions in which early detection is appropriate, because:

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Prediabetes

Prediabetes

Screening and Monitoring


Prediabetes1

Prediabetes

  • Epidemiologic evidence suggests that the complications of T2DM begin early in the progression from NGT to frank diabetes

  • Prediabetes and diabetes are conditions in which early detection is appropriate, because:

    • Duration of hyperglycemia is a predictor of adverse outcomes

    • There are effective interventions to prevent disease progression and to reduce complications

NGT, normal glucose tolerance; T2DM, type 2 diabetes mellitus.

Garber AJ et al. Endocr Pract. 2008;14:933-946.


Coronary heart disease in individuals with diabetes or prediabetes

Coronary Heart Disease in Individuals With Diabetes or Prediabetes

  • Substantial prevalence of diabetes and prediabetes among adults with CHD

    • Likely underestimated because of suboptimal screening

  • Clinical performance measures recommend that nondiabetic patients with CHD be screened for diabetes every 3 years

    • 1 of 4 nondiabetic adults with CHD reported not being screened for diabetes over the past 3 years

CHD, coronary heart disease.

Kilmer G, et al. Am J Prev Med. 2011;40:159-165.


Risk factors for prediabetes

Risk Factors for Prediabetes

  • Cardiovascular disease

  • Family history of diabetes

  • Hypertension

  • Dyslipidemia

  • Sedentary lifestyle

  • Overweight or obese

  • Non-Caucasian ancestry

  • Previously identified IGT, IFG, and/or metabolic syndrome

  • History of gestational diabetes

  • Delivery of a large baby(>9 lbs/4 kg)

  • Polycystic ovary disease

  • Treatment for schizophrenia or bipolar disease

IFG, impaired fasting glucose; IGT, impaired glucose tolerance.

Garber AJ, et al. Endocr Pract. 2008;14:933-946; Handelsman Y, et al. EndocrPract. 2011;17(suppl 2):1-53.


Normal fasting plasma glucose and risk of t2dm diagnosis

Normal Fasting Plasma Glucose and Risk of T2DM Diagnosis

  • Patients with normal fasting plasma glucose and any of the following comorbidities are at increased risk of developing diabetes:

    • Obesity

    • Hypertension

    • Low HDL cholesterol

    • High triglycerides

    • Smoking

  • Closer surveillance for diabetes development might be warranted in these patients

T2DM, type 2 diabetes mellitus.

Nichols GA, et al. Am J Med 2008;121:519-524.


Relative risk of developing diabetes

Relative Risk of Developing Diabetes

FPG (mg/dL)

≤8687-9091-99

8.23

(3.6-19.0)

5.26

(2.5-11.3)

Hazard ratio (95% CI)

2.65

(1.2-6.1)

2.42

(1.3-4.4)

1.76

(0.8-3.7)

1

Triglyceride level (mg/dL)

CI, confidence interval; FPG, fasting plasma glucose.

Tirosh A, et al. N Engl J Med. 2005;353:1454-1462.


Relative risk of developing diabetes1

Relative Risk of Developing Diabetes

FPG (mg/dL)

≤8687-9091-99

8.29

(3.8-17.8)

7.78

(3.2-18.7)

4.77

(2.3-9.7)

3.42

(1.4-3.5)

Hazard ratio (95% CI)

2.75

(1.2-6.3)

1.99

(0.9-4.3)

1.79

(0.8-4.1)

0.75

(0.2-2.7)

1

Body mass index (kg/m2)

CI, confidence interval; FPG, fasting plasma glucose.

Tirosh A, et al. N Engl J Med. 2005;353:1454-1462.


Interventional criteria for prediabetes

Interventional Criteria for Prediabetes

FPG, fasting plasma glucose; IFG, impaired fasting glucose; IGT, impaired glucose tolerance; OGTT, oral glucose tolerance test; NCEP, national cholesterol estrogen program.

HandelsmanY, et al. Endocr Pract. 2011;17(suppl 2):1-53; Garber AJ, et al. Endocr Pract. 2008;14:933-946.

  • IFG: FPG 100-125 mg/dL

  • IGT: 2-hour PPG 140-199 mg/dL

    • In patients with IFG, a 2-hour OGTT may further clarify the level of risk while also detecting undiagnosed diabetes

    • Patients with impaired glucose metabolism identified by 2-hour OGTT were greater in number than patients discovered by routine FPG

  • Metabolic syndrome diagnosed by the NCEP criteria should be considered a prediabetes equivalent

    • The metabolic syndrome predicts future diabetes better than IFG

    • 3 of 5 metabolic syndrome criteria are sufficient; recent evidence suggests even 2 of 5 metabolic syndrome criteria may be adequate


Clinical identification of metabolic syndrome

Clinical Identification of Metabolic Syndrome

ATP III, Adult Treatment Panel III; NCEP, National Cholesterol Education Panel; PAI-1, plasminogen activator inhibitor-1.

NCEP ATP III Final Report. NIH, NHLBI. 2002. Publication No. 02-5215.


Prevalence of metabolic syndrome

Prevalence of Metabolic Syndrome*

National Health and Nutrition Examination Survey 2009-2010

Prevalence (%)

(n=1169)

(n=384)

(n=481)

(n=2034)

*Defined as presence of ≥3 risk factors meetingNational Cholesterol Education Panel Adult Treatment Panel III (NCEP ATP III) criteria.

Beltrán-Sánchez H, et al. J Am CollCardiol. 2013;62:697-703.


Screening and diagnosing prediabetes

Screening and Diagnosing Prediabetes

IFG, impaired fasting glucose; IGT, impaired glucose tolerance.

HandelsmanY, et al. Endocr Pract. 2011;17(suppl 2):1-53.


Diabetes risk scores

Prediabetes Screening and Monitoring

Diabetes Risk Scores


Finnish diabetes risk score findrisc

Finnish Diabetes Risk Score (FINDRISC)

  • Risk assessment tool based on random samples of patients 35-64 years of age, followed for 5 years

    • 1987 cohort (n=4746)

    • 1992 cohort (n=4615)

  • Score range: 0-26

    • Score ≥9 predicts development of drug-treated diabetes within 10 years

      • Sensitivity 0.81 (1992 cohort)

      • Specificity 0.76 (1992 cohort)

      • Predictive value = 0.05 (1992 cohort)

Lindstrom J, Tuomilehto J. Diabetes Care. 2003;26:725-731.


Findrisc scores and abnormal glucose tolerance

FINDRISC Scores and Abnormal Glucose Tolerance

Prevalence of Diabetes and Abnormal Glucose Tolerance in Finnish Population (N=4622)

Diabetes prevalence (%)

AGT prevalence (%)

AGT, abnormal glucose tolerance; FINDRISC, Finnish Diabetes Risk Score.

Saaristo T, et al. Diabetes Vasc Dis Res. 2005;2:67-72.


Finnish diabetes risk score findrisc1

Finnish Diabetes Risk Score (FINDRISC)

Finnish Diabetes Association. Available at: http://www.diabetes.fi/files/1100/Type2diabetesRiskTest_.jpg.


Ada diabetes risk score

ADA Diabetes Risk Score

ARIC, Atherosclerosis Risk in Communities; CHS, Cardiovascular Health Study;NHANES, National Health and Nutrition Examination Survey.

Ban H, et al. Ann Intern Med. 2009;151:775-783.

  • Risk assessment tool based on NHANES 2006 cohort ≥20 years of age (N=5258) and validated with ARIC and CHS cohorts (N=19,728 combined)

  • Score range: 0-10

    • Score ≥5 predicts undiagnosed T2DM

      • Sensitivity 0.79

      • Specificity 0.67

      • Predictive value = 0.10


Ada risk scores and prevalence of undiagnosed diabetes

ADA Risk Scores and Prevalence of Undiagnosed Diabetes

Undiagnosed diabetes prevalence (%)

Diabetes risk score

AGT, abnormal glucose tolerance.

Ban H, et al. Ann Intern Med. 2009;151:775-783.


Ada diabetes risk score1

ADA Diabetes Risk Score

Ban H, et al. Ann Intern Med. 2009;151:775-783.

American Diabetes Association. Available at:http://www.diabetes.org/assets/pdfs/at-risk/risk-test-paper-version.pdf.


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