CE/CME

Prediabetes and Metabolic Syndrome: Current Trend

Clinician Reviews. 2015 October;25(10):42-49

References

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9. Garber AJ, Abrahamson MJ, Barzilay JI, et al. American Association of Clinical Endocrinologists’ comprehensive diabetes management algorithm 2013 consensus statement. Endocr Pract. 2013;19(suppl 2):1-48. www.aace.com/files/algorithm-07-11-2013.pdf. Accessed September 18, 2015.
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Prediabetes and metabolic syndrome are growing health concerns in the United States and around the world. Lack of awareness of current recommendations may lead to delays in treatment and subsequent increases in diabetes and cardiovascular disease. Evidence-based recommendations for the management of prediabetes and metabolic syndrome focus on lifestyle changes. The most effective strategies for the prevention of type 2 diabetes and management of metabolic syndrome are reviewed here.

The global prevalence of type 2 diabetes mellitus (T2DM) in adults has reached epidemic proportions. Approximately 285 million adults (ages 20-79), or 6.4% of the adult population, around the world are affected, and these numbers are expected to rise to 439 million (7.7%) by 2030.¹ In the United States, however, the prevalence is even higher, at 8.3% of the adult population.²

T2DM is a chronic disease that can cause significant morbidity and mortality. Diabetes is associated with macrovascular (eg, heart disease and stroke) as well as microvascular (eg, retinopathy, neuropathy, and microalbuminuria) complications.³ The economic cost of diagnosed diabetes in the US was approximately $245 billion in 2012.⁴ Early identification and management of prediabetes by nurse practitioners and physician assistants is essential to minimize disease prevalence and progression and to reduce the tremendous economic burden associated with T2DM.

PATHOPHYSIOLOGY AND RISK FACTORS FOR DIABETES
Diabetes is a complex disorder characterized by hyperglycemia resulting from insufficient insulin secretion and/or decreased tissue response to insulin.⁵ The progression of normal glucose tolerance to diabetes is a continuous process involving many organ systems. The disease develops primarily as a result of impaired insulin action in muscle, impaired insulin secretion from the pancreatic β-cells, and increased hepatic glucose production.⁶

In addition, defects in other organs, including increased free fatty acid production in the adipose tissue, decreased incretin effect in the digestive tract, increased glucagon secretion from the pancreatic α-cells, increased glucose reabsorption from the kidneys, and neurotransmitter dysfunction, lead to progression of diabetes.⁶ This phenomenon is called the ominous octet.⁶ Gradual increases in glucose levels have been detected as early as 13 years prior to diagnosis of diabetes, with an abrupt increase occurring in the final two to six years before diagnosis.⁷

Modifiable risk factors such as obesity, poor dietary intake, and a sedentary lifestyle have been associated with increased risk for T2DM.² Certain antipsychotic medications may also play a part in disease progression.³

According to the American Diabetes Association (ADA), screening for diabetes should begin at age 45 and be repeated every three years.⁸ For adults younger than 45, screening should be done in those with a BMI of 25 or higher and at least one of the following additional risk factors:
• Family history (first-degree relative with diabetes)
• Ethnicity (high-risk populations include African American, Latino, Native American, Asian American, Pacific Islander)
• History of polycystic ovary syndrome
• History of gestational diabetes (GDM) or delivering a baby weighing more than 9 lb
• Physical inactivity
• Hypertension and/or hyperlipidemia
• History of cardiovascular disease (CVD)
• Insulin resistance.⁸

IDENTIFICATION/DIAGNOSIS OF PREDIABETES
Diabetes is preceded by an asymptomatic phase known as prediabetes. In prediabetes, blood glucose levels are higher than normal but do not meet the criteria for diabetes.⁸ According to the American Association of Clinical Endocrinologists (AACE) and the ADA, prediabetes is defined as impaired fasting glucose (fasting plasma glucose level of 100-125 mg/dL) and/or impaired glucose tolerance (two-hour plasma glucose value of 140-199 mg/dL after a 75-g oral glucose tolerance test).^8,9 The ADA also considers a hemoglobin A1C value of 5.7% to 6.4% to be indicative of prediabetes.⁸

In the US, it is estimated that more than 79 million adults have prediabetes.² Approximately 70% of individuals with prediabetes will progress to T2DM.⁷ Prediabetes not only increases the risk for T2DM but is also associated with an increased risk for microvascular and macrovascular complications and end-organ damage.³ Impaired fasting glucose and impaired glucose tolerance are linked with obesity, lipid abnormalities, and hypertension.⁸ Early identification and treatment of prediabetes is therefore important to prevent or delay the onset of diabetes as well as its complications.³

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Prediabetes and Metabolic Syndrome: Current Trend

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