Screening for Prediabetes

Kelly Moore, MD, FAAPIHS Division of Diabetes Treatment &

Prevention

Overview

• Diagnosis of Prediabetes

• Screening Strategies

• Draft Core Elements for Screening

• Grantee Panel Discussion

• Questions/Discussion

Prediabetes Definition

Individuals with abnormal glucose regulation intermediate between the normal state and the state of diabetes

• Impaired Fasting Glucose (IFG)

• Impaired Glucose Tolerance (IGT)

Importance of detection• Each year, 10-28 percent develop diabetes

• Research: Lifestyle changes can reduce risk of developing diabetes

Prediabetes Detection and treatment will also:

Identify undiagnosed diabetes in some individuals

Identify undiagnosed hypertension and undiagnosed dyslipidemias in some patients

Lay the groundwork for healthy lifestyle changes

Stages in the natural history of diabetes

Normal IGT Type 2 Diabetes

Complications Disability Death

Genetic Predisposition

Preclinical State Clinical disease Complications Death Disability

Primary Prevention Secondary Prevention Tertiary Prevention

Diagnosis of Prediabetes

Classification and Tests

Impaired Fasting Glucose (IFG)• Fasting Blood Glucose (FBG) 100 –

125

Impaired Glucose Tolerance (IGT)• 2 hour Oral Glucose Tolerance Test (OGTT)140 - 199

Comparison of Test Results

Test Normal Prediabetes Diabetes

FBG(mg/dl)

< 100 100-125

(IFG)

>125

OGTT – 2hr result(mg/dl)

< 140 140-199

(IGT)

≥ 200

Overlap of IGT and IFG

Both IFGIGT

Screening for Prediabetes Targeted vs. Universal Screening

Targeted Screening• more cost effective• Universal Screening not routinely

recommended

Screen individuals 18 years and older with risk factors for Prediabetes or Metabolic Syndrome

Overweight, Obesity Hypertension Low HDL, high TG Women with a history of GDM Family history of diabetes

Screening for Prediabetes In practice, several strategies:

Community settings• Strategies include:

Paper risk tests Fingerstick glucose tests

• Importance of Follow-up

Clinical settings• Random blood glucose• Fasting blood glucose• 2 hr Oral Glucose Tolerance Test

CGP Considerations Eligibility for Intensive Activities

Prediabetes – IFG, IGT• Consistent with DPP, other studies• Metabolic Syndrome – may consider eligibility later

in demonstration project

Screening Activities• Opportunity to see what works, lessons learned• Potential benefits for other Indian health programs

Core Element: Screening Draft Protocol/Required Elements

Developed in context of:• IHS Prediabetes Guidelines• Informal grantee input at previous meetings• Discussion with technical experts• IHS DDTP recommendations

Target screening of individuals with risk factors

Possible Settings for Screening• Community• Clinical Setting

Core Element: Screening Community Screening

Assessment of Risk Paper Risk Test, AND Fingerstick Glucose

If either positive Refer to clinic OGTT – results include both FBG and 2 hr value FBG alone not enough – may miss some with undiagnosed

diabetes

Possible evaluation activity Compare use of paper risk test, fingerstick glucose, FBG, OGTT May result in lessons learned for other Indian health programs

Core Element: Screening Outcomes of screening

Normal resultsEducation on risks for diabetes

Prediabetes (IFG or IGT)Recruit to enter Intensive Activities

DiabetesRefer to clinic for further care

Next Steps

Draft protocol/required activitiesHandout for binderDiscuss with team

Grantee panel discussionExperience with screening for

prediabetes

Questions/Discussion/InputAll grant programs