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Feature Article

Prediabetes: preventing progression to diabetes

Angela S Lee, Jeff R Flack

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Abstract

Patients with prediabetes (impaired fasting glucose or impaired glucose tolerance) are at increased risk of developing type 2 diabetes and cardiovascular disease. Evidence supports intensive lifestyle management to help prevent or delay the progression to diabetes. Metformin has also shown benefit but is not approved for this indication in Australia.

Key Points

  • Prediabetes describes a state of impaired glucose regulation, where blood glucose levels are elevated above normal but not high enough to fulfil the diagnostic criteria for diabetes.
  • Prediabetes is incidentally detected when assessing patients for type 2 diabetes.
  • Prediabetes is defined as a plasma glucose level in the range 6.1 to 6.9 mmol/L after fasting (impaired fasting glucose); or the range 7.8 to 11.0 mmol/L at two hours after a 75 g oral glucose load (impaired glucose tolerance).
  • People with prediabetes have an increased risk of developing diabetes, cardiovascular disease and premature death.
  • Intensive lifestyle modification is effective in reducing progression of prediabetes to diabetes and should focus on weight loss, increased physical activity and dietary change.
  • Pharmacological agents such as metformin can be considered in people with prediabetes, but this use is not TGA approved or PBS subsidised.

    Picture credit: © Diego_Cervo/Deposit Photos. Models used for illustrative purposes only.

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