Patients with type 2 diabetes (T2D) constitute approximately 90%-95% of all patients with diabetes worldwide. In 2013, 382 million adults were diagnosed with diabetes worldwide. This number is expected to grow to 592 million in 2035. About 1 in 3 adults and 1 in 5 adolescents in the U.S. have prediabetes, but most are unaware. Prediabetes is the term used for individuals with a slightly elevated A1C, impaired fasting glucose, and/or impaired glucose tolerance and indicates an increased risk for the future development of diabetes and cardiovascular disease. Help limit progression to diabetes...
Identify patients at risk ã…¡ Check an A1C or fasting blood glucose. Guidelines vary, BUT usually screen starting at age 45 or younger for adults at high risk, such as those with a BMI of 25 or higher plus at least one more risk factor (hypertension, CV disease, etc).
Also screen kids after onset of puberty or age 10 and up, whichever comes first, if they’re overweight and have at least one other risk factor, such as a family history of type 2 diabetes. Consider prediabetes if patients have an A1C of 5.7% to 6.4% OR a fasting blood glucose of 100 to 125 mg/dL. Rescreen at least every 3 years if results are normal.
Emphasize lifestyle changes ã…¡ Recommend at least 150 min/week of moderate physical activity, such as brisk walking. Explain that just a few minutes at a time count toward the weekly goal. Encourage overweight patients to try for 5% to 10% weight loss as a reasonable target, but even less may lower risk.
Suggest trying the "PLATE METHOD": Advise filling half of the plate with non-starchy vegetables (broccoli, etc) and a quarter each with starch (whole-grain rice, etc) and lean protein (fish, etc). Acknowledge that lifestyle changes can be tough, but they can prevent diabetes in about 1 in 7 adults when maintained for 3 years. Recommend a healthy lifestyle for kids and teens too at least 60 minutes of physical activity daily, less screen time, etc.
Consider medications if needed ã…¡ Think of metformin (Glucophage) for adults most likely to benefit, such as a BMI of 35 or over, a history of gestational diabetes, or under age 60 especially if lifestyle changes aren’t enough after 3 to 6 months. Metformin prevents diabetes in 1 in 14 adults over 3 years. But don’t jump to medications for diabetes prevention in KIDS, there’s no good evidence compared to adults.
REFERENCES
Prevention or Delay of Type 2 Diabetes: Standards of Medical Care in Diabetes—2021
Consensus Statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the Comprehensive Type 2 Diabetes Management Algorithm – 2019 Executive Summary