July 2008 - For the first time, a consensus of diabetes and metabolic disorder experts have recommended a comprehensive treatment regimen for patients with pre-diabetes. The recommendations call for specific guidelines on both lifestyle, and pharmaceutical intervention where appropriate. The recommendations are made in a Consensus Statement released this morning by the American College of Endocrinology (ACE) and the American Association of Clinical Endocrinologists (AACE).
Pre-diabetes is a condition defined by elevated fasting glucose levels or impaired glucose tolerance. According to the Centers for Disease Control (CDC), more than 56 million Americans currently have the condition, which leaves patients at risk, not only for developing type 2 diabetes, but also for cardiovascular complications. This is an extension of the effort to recognize and treat type 2 diabetes earlier and more aggressively.
However, at this time, there are no pharmacologic therapies that have been approved by the FDA for prevention of the conversion of pre-diabetes to diabetes. That's why the expert panel has recommended a two-pronged approach to treating pre-diabetes. The first is intensive lifestyle management to prevent the progression to type 2 diabetes.
"As individuals and as a society, we need to address those forces which are creating the epidemic of obesity, diabetes, and pre-diabetes," said Yehuda Handelsman MD, FACP, FACE, Treasurer of AACE and Medical Director of the Metabolic Institute of America. "We understand the difficulties in implementing solutions, but as an association of endocrinologists we are committed to supporting community and national efforts in every way we can."
The recommendation calls for patients to adhere to the guidelines set forth in the Diabetes Prevention Program, established by the United States government.
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"Although lifestyle can clearly modify the progression of patients towards overt diabetes, it may not be sufficient," said Alan J. Garber, MD, PhD, FACE, Professor of Medicine, Baylor College of Medicine, Houston, and Chairman of the Consensus Conference. "Medications may well be required, particularly in high risk groups."
The second approach is to prevent the development of cardiovascular complications, and to help those patients where lifestyle modifications have been insufficient to modify cardiovascular risk factors. This requires cardiovascular risk reduction medications for abnormal blood pressure and cholesterol independent of glucose control medications.
"The data show that there is a spectrum of severity, with the most severely affected approaching the risks of people with diagnosed type 2 diabetes," said Daniel Einhorn, MD, FACP, FACE, Vice President of AACE and Medical Director of the Scripps Whittier Institute for Diabetes in La Jolla, CA. "In these highest risk individuals, who represent a minority, pharmacologic strategies may be appropriate if intensive lifestyle therapies fail. Regardless, all individuals at risk for diabetes should be aware of the level of their risk factors and be prepared to take action."
While the number of people with pre-diabetes in the United States exceeds 56 million, most patients with the condition have not been diagnosed. People are considered high risk if they have near diabetic levels of blood glucose, hypertension, or abnormal lipid profiles. These patients should consider working with their doctor to monitor their status.
Source: American Association of Clinical Endocrinologists
