Fasting blood glucose levels are in a continuum within a given population, with higher fasting glucose levels corresponding to a higher risk for complications caused by the high glucose levels. Impaired fasting glucose is defined as a fasting glucose that is higher than the upper limit of normal, but not high enough to be classified as diabetes mellitus. Some patients with impaired fasting glucose can also be diagnosed with impaired glucose tolerance, but many have normal responses to a glucose tolerance test.
WHO criteria for impaired fasting glucose differs from the (American Diabetes Association) ADA criteria, because the normal range of glucose is defined differently. Fasting glucose levels 100 mg/dL and higher have been shown to increase complication rates significantly. However, WHO opted to keep its upper limit of normal at under 110 mg/dL for fear of causing too many people to be diagnosed as having impaired fasting glucose, whereas the ADA lowered the upper limit of normal to a fasting glucose under 100 mg/dL.
WHO criteria: fasting plasma glucose level from 6.1 mmol/l (110 mg/dL) to 6.9 mmol/l (125 mg/dL).
These are associated with insulin resistance and are risk factors for the development of type 2 diabetes mellitus. Those in this stratum (IGT or IFG) are at increased risk of cardiovascular disease. Of the two, impaired glucose tolerance better predicts cardiovascular disease and mortality.
In a way, prediabetes is a misnomer since it is an early stage of diabetes. It is now known that the health complications associated with type 2 diabetes often occur before the medical diagnosis of diabetes is made.
The American College of Endocrinology (ACE) and the American Association of Clinical Endocrinologists (AACE) have developed lifestyle intervention guidelines for preventing the onset of type 2 diabetes:
Some limited studies showed that low-carb diet & low glycemic index carbs is a valuable prevention and treatment tool in diabetes and prediabetes. Previous advice focused on low-fat approach.. However the vast majority of the evidence favours a minimum of 130g of carbohydrate per day with carbohydrate foods providing between 45-65% of total calories. Dietary carbohydrate (amount and type) in the prevention and management of diabetes: a statement by the American diabetes association.
Don’t smoke – Smoker can plan to quit. Smoking increases the risk factor for diabetes.
Alcohol – drinkers do so only in moderation and always with a meal.
Stress – Stress causes hormonal imbalance and prevents insulin to work normally and end up with a diabetes. So take the stress seriously and try to be calm or practice meditation.
Levels above these limits would be a diagnosis for diabetes.
For patients with severe risk factors, prescription medication may be appropriate. This can be considered in patients for whom lifestyle therapy has failed or is not sustainable and who are at high-risk for developing type 2 diabetes. and acarbose help prevent the development of frank diabetes, and also have a good safety profile. Evidence also supports thiazolidinediones but there are safety concerns, and data on newer agents such as GLP-1 receptor agonists, DPP4 inhibitors or meglitinides are lacking.
Category:Diabetes Category:Medical conditions related to obesity Category:Nutrition
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