Michael Bergman, M.D.
Dr. Michael Bergman appeared on ABC-TV's Eyewitnesss News October 28, 2008 discussing how pre-diabetes is underdiagnosed. Watch the video and read the article on the ABC Eyewitness News website.
Pre-diabetes represents an intermediate stage of altered glucose metabolism between normal glucose levels and type 2 diabetes that is associated with an increased risk for the development of diabetes and other complications such as coronary artery disease and eye problems. It is estimated that approximately 54 million Americans over the age of 21 years have prediabetes. Twenty-five per cent of very obese children and 21% of very obese adolescents may have pre-diabetes.
Pre-diabetic states include impaired fasting glucose (IFG), defined as a fasting glucose level between 100-125 mg/dL and impaired glucose tolerance (IGT) defined by a 2-hour response to a 75 gram oral glucose tolerance test between 140-199 mg/dL. IFG and IGT are both associated with insulin resistance. Progression to diabetes occurs over an extended time, often over many years although the onset of diabetes can also be rapid. The incidence of subsequent diabetes is highest in individuals with combined IGT and IFG and similar in those with isolated IFG and IGT. The risk of someone with a normal glucose tolerance for developing diabetes is 0.7% per year whereas the risk is about 5-10% per year in individuals with pre-diabetes. However, the natural history is variable with 25% progressing, 50% remaining unchanged and 25% reverting to normal glucose concentrations over 3-5 years.
The progression to diabetes is not inevitable and can be best averted by lifestyle modification including weight loss, following a diet low in total and saturated fat and having adequate fiber and exercise (30-60 minutes daily five days per week). Certain individuals at particularly high risk for developing diabetes (for example, with a history of gestational diabetes, polycystic ovary syndrome, or metabolic syndrome) may be candidates for drug therapy as metformin. Screening for prediabetes should be undertaken in individuals 45 years or older particularly if they are overweight (BMI > 25 kg/m2) and under 45 years if they are overweight with any risk factors comprising any of the following: inactivity, having a first degree relative with diabetes, member of a high risk ethnic population, history of hypertension, having delivered a baby greater than 9 lbs or having been diagnosed with gestational diabetes, lipid abnormality (low HDL-cholesterol or elevated triglyceride), history of polycystic ovary syndrome or a history of vascular disease.