Thursday, July 24, 2008
Guidelines aim to clarify treatment of pre-diabetes
The
The guidelines recommend prescribing metformin or acarbose to high-risk patients, such as those with cardiovascular disease or worsening glycemia; statins to lower LDL cholesterol to 100 mg/dL; and ACE/ARB inhibitors to reach target blood pressure of 130/80 mmHg. Patients should undergo glucose and microalbuminuria testing annually and have fasting plasma glucose, hemoglobin A1C and lipids tests every six months, the guidelines state.
Physicians often have little success getting patients to embrace lifestyle changes, such as following a low-fat diet and exercising daily, as recommended in the guidelines. Will the new recommendations encourage more use of medications to control symptoms in patients at risk for diabetes? What are you doing in your practice?
Labels: Diabetes
posted by Janet Colwell at
2:06 PM
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4 Comments:
Why not use A1C levels to define prediabetes? (6.0-6.5)
When will Endocrinology send glucose tolerance torture to the bins of history?
Why the low fat diet? Why not a 100 gram carbohydrate diet? Low fat is high carb by definition.
Dr. Castello, you make several good points. Since I'm working on an article about prediabetes treatment right now, I am particularly interested in the expert diabetes' community (i.e., the ADA and AACE) seeming lack of interest in low-carb diets. Any ideas about why that is? And does anyone out there have a defense of the glucose tolerance test?
Dr. Castello & Stacey:
Being a Fellow of both ACP and ACE, I think I can try to bridge the understanding of pre-diabetes.
It is a misconception that Endocrinologists don't use low-carb diets; quite the contrary in clinical practice. We just don't prescribe the Atkins-type diets that are loaded with saturated fats & cholesterol and are ketogenic (bad for diabetics!). BTW, low-fat is not necessarily high-carb. We suggest low-carb, low saturated fat, high fiber diets. The pecentage of carbs depends on the activity level of the individual. We permit mono-unsaturated fats, just not saturated fats.
As far as OGTT i concerned, I have not done more than 3 in over 9 years of Endocrine practice. What is missing from the ACE paper is that one can use Random Plasma Glucose of 141-200 as a criteria for IGT, in addition to 2-hr OGTT. Clearly glucose tolerance tests have their value, mainly in screening for Gestational Diabetes, which (in the appropriate circumstances) can be a precursor for type 2 diabetes.
Since pre-diabetes is composed of either IFG and/or IGT, and intervention for IFG is different from IGT, it is very important to determine what type of pre-diabetes a patient has. Hence the need to screen with post-load glucose value.
Hope this answers the questions.
Dr. Cavale,
Thank you. Your explanations perfectly answered my questions, although I am now curious about why the ACE did not suggest random plasma glucose, since it seems like it would usually be the most efficient, effective test.
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