Saturday, July 26, 2008

New Guidelines Recommended for Treatment of Prediabetes

For the first time, a panel of experts in diabetes and metabolic disorders has issued a comprehensive regimen of guidelines for diabetes prevention. Prediabetes (elevated fasting glucose levels or impaired glucose tolerance) remains undiagnosed in the majority of our population, and is thought to exceed the number of people who are aware of the condition. The burden on health includes a significant risk of developing Type 2 diabetes and heart disease. The known prevalence of diabetes in the US is currently 56 million.

The American Association of Clinical Endocrinologists (AACE) is expected to issue their final document later this year in Endocrine Practice. In a news release, Yehuda Handlesman MD, FACP, FACE, treasurer of AACE and medical director of the Metabolic Institute of America says, “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 new guidelines will include specific lifestyle changes, and medication recommendations when appropriate for those at risk. The goal is to recognize and treat type 2 diabetes early and aggressively.

The panel plans to use a two-fold approach. High risk groups may require medications to lower cholesterol and treat hypertension when lifestyle modification fails. Alan J. Garber, MD, PhD, FACE, professor of medicine, Baylor College of Medicine in Houston, Texas, and chairman of the Consensus Conference says, "Although lifestyle can clearly modify the progression of patients towards overt diabetes, it may not be sufficient. Close monitoring by family physicians is recommended for high risk groups.

Normal blood sugar levels are defined when fasting, at less than 100 mg/dl and glucose tolerance challenges less than 140 mg/dl. When blood glucose levels reach 126 in a fasting state and 200mg/dl after a glucose challenge, a diagnosis of diabetes is made. Those in the middle are poorly defined.

Lifestyle management is desirable because it is safe and can be an effective tool for reducing heart disease risk and the development of diabetes. Exercise, 5 days a week at moderate intensity has been recommended, though a recent study shows that high intensity interval exercise may be even more beneficial. Further recommendations include aspirin for prediabetic patients who are not at risk of bleeding. Guidelines for prediabetic cholesterol and blood pressure management are the same as those with diabetes.

Standards for diabetes prevention include the following dietary recommendations:

Primary prevention of diabetes

•Among individuals at high risk for developing type 2 diabetes, structured programs that emphasize lifestyle changes that include moderate weight loss (7% body weight) and regular physical activity (150 min/week), with dietary strategies including reduced calories and reduced intake of dietary fat, can reduce the risk for developing diabetes and are therefore recommended.
•Individuals at high risk for type 2 diabetes should be encouraged to achieve the U.S. Department of Agriculture (USDA) recommendation for dietary fiber (14 g fiber/1,000 kcal) and foods containing whole grains (one-half of grain intake).

Dietary fat intake in diabetes management

•Saturated fat intake should be <7% of total calories.
•Intake of trans fat should be minimized.

Carbohydrate intake in diabetes management

•Monitoring carbohydrate intake, whether by carbohydrate counting, exchanges, or experience-based estimation, remains a key strategy in achieving glycemic control.
•For individuals with diabetes, the use of the glycemic index and glycemic load may provide a modest additional benefit for glycemic control over that observed when total carbohydrate is considered alone.

Other nutrition recommendations

•Sugar alcohols and nonnutritive sweeteners are safe when consumed within the acceptable daily intake levels established by the Food and Drug Administration (FDA).
•If adults with diabetes choose to use alcohol, daily intake should be limited to a moderate amount (one drink per day or less for adult women and two drinks per day or less for adult men).
•Routine supplementation with antioxidants, such as vitamins E and C and carotene, is not advised because of lack of evidence of efficacy and concern related to long-term safety.
•Benefit from chromium supplementation in people with diabetes or obesity has not been conclusively demonstrated and, therefore, cannot be recommended.

The above recommendations can be found at:

The recommendations from the AACE for intensive screening, lifestyle changes,including nutrition and weight loss in addition to testing and monitoring of prediabetes are expected to decrease hospitalizations, provide healthcare savings, and decrease years of disease burden for those who are already at risk.

Source: AACE Consensus Statement of the AACE Task Force on Pre-diabetes. Released July 23, 2008. ◦