Glucose Intolerance

Glucose Intolerance is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • Glucose intolerance is an intermediate stage between a normal glucose metabolism and diabetes.
  • Individuals with impaired fasting glucose (IFG) and/or impaired glucose intolerance (IGT) have been referred to as having prediabetes:
    • IFG: 100 to 125 mg/dL
    • IGT: 140 to 199 mg/dL 2 hours after ingestion of 75 g oral glucose load
    • Hemoglobin A1c (HbA1c) 5.7–6.4% (1)

Epidemiology

  • As of 2010, it is estimated that one of every three U.S. adults ≥20 years of age have prediabetes (2).
  • An estimated 86 million people in the United States are living with prediabetes.
  • Only 11% of people with prediabetes are aware of their condition (3).
  • Prediabetes has a 37% prevalence among adults >20 years old and 51% of adults ≥65 years in the United States (4).

Incidence
  • Systematic review indicates a 5-year cumulative incidence of developing diabetes of 9–25% for people with an HbA1c of 5.5–6.0% and 25–50% with an HbA1c of 6.0–6.5% (1).
  • Highest incidence in American Indians/Alaska Natives, non-Hispanic blacks, and Hispanics (2)

Etiology and Pathophysiology

Progressive loss of insulin secretion on the background of insulin resistance (1)

Risk Factors

  • Body mass index (BMI) ≥25: overweight
  • Obesity and metabolic syndrome
  • History of gestational diabetes mellitus (GDM)
  • Sedentary lifestyle
  • Medications (see “Differential Diagnosis”)
  • Genetic factors. Variants in 11 genes have been shown to be significantly associated with future development of type 2 diabetes and IFG. Variants in 8 of these genes have been associated with impaired β-cell function.

General Prevention

  • Lifestyle modification with weight reduction and increased physical activity
  • A decrease in excess body fat provides the greatest risk reduction.
Pregnancy Considerations
  • Screening for diabetes in pregnancy is based on risk factor analysis:
    • High risk: first prenatal visit
    • Average risk: 24 to 28 weeks’ gestation
  • Women with GDM should be screened for diabetes 6 to 12 weeks’ postpartum with 75-g OGTT and then every 1 to 3 years via any method (5).

Commonly Associated Conditions

  • Obesity (abdominal and visceral obesity)
  • Dyslipidemia with high triglycerides (TG)
  • Metabolic syndrome
  • PCOS
  • GDM
  • Low HDL
  • HTN
  • Congenital diseases (Down, Turner, Klinefelter, and Wolfram syndromes)

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