Manage Patients With Prediabetes the Same as Patients With Type 2 Diabetes
ORLANDO—With 20% of the US population living with prediabetes—and those 84 million Americans having a 5-fold greater risk of developing type 2 diabetes mellitus—it is imperative that individuals with prediabetes be identified and started on a diabetes prevention program immediately, according to Andrea M. Stallings, MS, PA-C, CDE, who presented today at Consultant360’s Cardiometabolic Risk Summit 2019.
One of the first steps in delaying patients’ progression of diabetes is to identify which patients are at risk for developing type 2 diabetes using the American Diabetes Association (ADA) or Centers for Disease Control and Prevention (CDC) risk calculator.
To delay—and even prevent—type 2 diabetes, Stallings also recommends that clinicians follow the ADA 2019 Standards of Medical Care. Included among these standards are to:
- Annually monitor for the development of type 2 diabetes in those with prediabetes.
- Refer patients with prediabetes to an intensive behavioral lifestyle intervention program modeled after the Diabetes Prevention Program.
- Have patients reach and maintain a 7% loss of initial body weight.
- Encourage patients to increase their moderate-intensity physical activity to at least 150 minutes a week.
- Consider technology-assisted diabetes prevention interventions.
- Consider metformin therapy for those with prediabetes—especially in those with a body mass index of 35 kg/m2 or greater, in those who are older than 60 years, and in women with prior gestational diabetes.
According to Stallings, the standard that clinicians refer patients to an approved Diabetes Prevention Program is one that is often not followed. As such, few high-risk patients attend these programs. To help bridge the gap in the number of practitioners who recommend Diabetes Prevention Programs, Stallings explained how a clinician can locate a CDC-recognized program within close proximity to the patient or an online resource.
Stallings also highlighted how weight loss and lifestyle modifications have proven to delay or prevent type 2 diabetes and listed nutrition and fitness tracker applications that patients may want to utilize.
Ultimately, Stallings says that managing prediabetes should not be that different than managing risk factors for type 2 diabetes. And management may be more successful if clinicians set small, realistic goals with their patients.
Stallings AM. Prediabetes: individualizing the treatment approach to delay the progression to diabetes. Talk presented at: Consultant360’s Cardiometabolic Risk Summit 2019; October 24-26, 2019; Orlando, FL.