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Prediabetes: A Prevalent and Treatable, but Often Unrecognized, Clinical Condition

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Pathophysiology of Prediabetes

The same pathophysiologic defects lie at the heart of both IFG and IGT: beta cell dysfunction and insulin resistance. In both IFG and IGT, glucose-stimulated insulin secretion is impaired.11 There is also fasting hyperinsulinemia due to a compensatory pancreatic beta cell response to fasting hyperglycemia.12 However, there are differences between IFG and IGT. IFG is associated with a more severe hepatic insulin resistance than IGT.12, 13 IGT is associated with insulin resistance in skeletal

Identifying Risk Factors for Prediabetes

The risk factors for prediabetes are the same as those for type 2 diabetes. The ADA recommends testing asymptomatic adults for type 2 diabetes if they meet any of the criteria (Figure) that indicate increased risk for type 2 diabetes.10

The following case presentation illustrates the importance of recognizing prediabetes and identifies lifestyle modifications that can be used to treat prediabetes in clinical settings. The assessment, intervention, monitoring, and evaluation were done in an

Discussion

Lifestyle intervention is recommended for individuals with prediabetes to prevent or delay the onset of type 2 diabetes, postpone pharmacologic treatment, preserve beta cell function, and reduce the likelihood of microvascular and cardiovascular complications.4, 34, 35 The Diabetes Prevention Program demonstrated that the dominant predictor of reduced type 2 diabetes incidence was weight loss.32 Thus, when developing an intervention for a patient with prediabetes, comprehensive lifestyle change

J. D. Eikenberg is a medical student, Virginia Tech Carilion School of Medicine, Roanoke.

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    J. D. Eikenberg is a medical student, Virginia Tech Carilion School of Medicine, Roanoke.

    B. M. Davy is an associate professor, Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg.

    FUNDING/SUPPORT This work was supported in part by National Institutes of Health grant no. R01DK082383.

    STATEMENT OF POTENTIAL CONFLICT OF INTEREST The authors do not have any conflicts of interest to disclose.

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