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- 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)
- 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).
Etiology and Pathophysiology
Progressive loss of insulin secretion on the background of insulin resistance (1)
- 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.
- Lifestyle modification with weight reduction and increased physical activity
- A decrease in excess body fat provides the greatest risk reduction.
- 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
- Low HDL
- Congenital diseases (Down, Turner, Klinefelter, and Wolfram syndromes)