Pre-diabetes management

There has been a drastic increase in the incidence of type 2 diabetes mellitus in developing countries over the last few years. Assessment for pre-diabetes should be considered of vital importance in primary care.

Risk Factors to assess for:
  1. Age ≥ 45 years without other risk factors
  2. CVD
  3. Family history of T2DM
  4. Overweight or obese
  5. Sedentary
  6. Member of an at-risk ethnic group
  7. HDL-C < 35 mg/dL and/or TG > 250 mg/dL
  8. Impaired Fasting Glucose
  9. Metabolic Syndrome
  10. Acanthosis Nigricans
  11. Hypertension
  12. History of gestational diabetes
  13. Antipsychotic therapy
  14. Chronic glucocorticoid exposure
  15. Sleep disorders in the presence of glucose intolerance (A1C > 5.7%)

The American Association of Clinical Endocrinologists and the American College of Endocrinology recommend:
  • Screening in the presence of risk factors for DM.
  • Individuals at risk for DM whose glucose values are in the normal range should be screened every 3 years
  • Clinicians may consider annual screening for patients with 2 or more risk factors
AACE/ACE also recommends using the following criteria to diagnose DM
  • HgA1C level ≥6.5%
  • Symptoms of hyperglycemia with random plasma glucose concentration of ≥200 mg/dL
  • Serum glucose concentration ≥126 mg/dL after 8 or more hours of no caloric intake
Finally,
It is recommended clinicians incorporate one of the following medications in patients with moderate to high risk of developing DM :
  • Metformin
  • Acarbose
  • Thiazolidinediones
Non-pharmacologic Interventions to Recommend
  • Weight loss (5-10% of weight)
  • Immunizations (influenza, pneumococcal)
  • Moderate Physical Activity (walking minimum of 150 minutes per week)
  • Dietary Modifications (regular meals, no fasting, lower glycemic foods, multigrain bread, whole grains, beans, legumes, healthy fats, nuts, avocados, limit saturated fats, consume protein from low saturated fats, lean animal protein)
  • assess for cardiovascular disease.



Diagnostic Tests to Consider
  • CBC
  • CMP
  • Fasting lipid panel
  • HgA1C


Role of the Nurse Practitioner in the management of pre-DM
  • Assess for the development of microvascular complications such as diabetic nephropathy, neuropathy, and retinopathy
  • Performing thorough workups (Random Plasma Glucose, Serum Fasting Glucose, BUN/Creatinine, UA, HgbA1C)
  • Collaborate (with RNs, and other consulting specialists)
  • Maintain goal of therapy (BS 70-100, BP < 130 / 80 mmHg, and TG < 150)
References
If you need more information here is the link to the AACE/ACE Consensus Statement for the management of DM type 2 


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