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Screening for Prediabetes
#1
It is recommended that individuals who meet any of the clinical risk criteria noted below should be screened for prediabetes or Type 2 diabetes. 

  • CVD or family history of T2D
  • Overweight or obese
  • Sedentary lifestyle
  • Member of an at-risk racial or ethnic group:
    • Asian
    • African American
    • Hispanic
    • Native American (Alaska Natives and American Indians)
    • Pacific Islander
  • High-density lipoprotein cholesterol (HDL-C) <35 mg/dL (0.90 mmol/L) and/or a triglyceride level >250 mg/dL (2.82 mmol/L)
  • Impaired glucose tolerance (IGT), impaired fasting glucose (IFG), and/or metabolic syndrome
  • Polycystic ovary syndrome (PCOS), acanthosis nigricans, or nonalcoholic fatty liver disease (NAFLD)
  • Hypertension (blood pressure >140/90 mm Hg or on antihypertensive therapy)
  • History of gestational diabetes or delivery of a baby weighing more than 4 kg (9 lb)
  • Antipsychotic therapy for schizophrenia and/or severe bipolar disease
  • Chronic glucocorticoid exposure
  • Sleep disorders in the presence of glucose intolerance (A1C >5.7%, IGT, or IFG on previous testing), including obstructive sleep apnea (OSA), chronic sleep deprivation, and night-shift occupation
[*]In the event of normal results, repeat testing at least every 3 years. Clinicians may consider annual screening for patients with 2 or more risk factors (1).
Medications and Prediabetes Risk 

Specific medications that increase prediabetes risk include:






  1. Antidepressants: The ongoing use of antidepressant medications may modestly increase the risk of developing prediabetes or T2D, although the elevation in absolute risk is modest (2).

  2. Psychotropic agents: Certain treatments for schizophrenia or bipolar disease may increase prediabetes, T2D, and/or CVD risk. Substantial weight gain has been associated with psychotropic agents, including some antipsychotic medications. These medications are also associated with adiposity-dependent and possibly adiposity-independent changes in insulin sensitivity and lipid metabolism (3). Among the second- and first-generation antipsychotics, respectively, clozapine and olanzapine and thioridazine and chlorpromazine have been associated with an increased risk of T2DM and dyslipidemia.








[*]Diagnostic Criteria 

A diagnosis of prediabetes should be made according to glucose criteria, although the metabolic syndrome is considered a prediabetes equivalent (1).

[*]
Glucose criteria. Glucose criteria for the diagnosis of prediabetes and diabetes appear in Table 1 (1,4). Prediabetes may be identified by the presence of impaired glucose tolerance (IGT; plasma glucose 140-199 mg/dL 2 hours after ingesting 75 g of glucose) and/or impaired fasting glucose (IFG; fasting glucose 100-125 mg/dL). A1C values between 5.5% and 6.4% inclusive should be a signal to do more specific glucose testing but should not be considered diagnostic. For prediabetes, A1C testing should be used only as a screening tool; FPG measurement or an oral glucose tolerance test (OGTT) should be used for definitive diagnosis.
.pdf   Table 1d.pdf (Size: 117.71 KB / Downloads: 0)

[*]References


  1. Handelsman Y, Bloomgarden ZT, Grunberger G, et al. American Association of Clinical Endocrinologists and American College of Endocrinology: clinical practice guidelines for developing a diabetes mellitus comprehensive care plan—2015. Endocr Pract. 2015;21:1-87.

  2. Kivimaki M, Hamer M, Batty GD, et al. Antidepressant medication use, weight gain, and risk of type 2 diabetes: a population-based study. Diabetes Care. 2010;33:2611-2616.

  3. Newcomer JW. Antipsychotic medications: metabolic and cardiovascular risk. J Clin Psychiatry. 2007;68(suppl 4):8-13.

  4. Garber AJ, Handelsman Y, Einhorn D, et al. Diagnosis and management of prediabetes in the continuum of hyperglycemia: when do the risks of diabetes begin? A consensus statement from the American College of Endocrinology and the American Association of Clinical Endocrinologists. Endocr Pract. 2008;14:933-946.

  5. Lorenzo C, Williams K, Hunt KJ, Haffner SM. The National Cholesterol Education Program - Adult Treatment Panel III, International Diabetes Federation, and World Health Organization definitions of the metabolic syndrome as predictors of incident cardiovascular disease and diabetes. Diabetes Care. 2007;30:8-13.

  6. National Cholesterol Education Program Expert Panel on Detection E, Treatment of High Blood Cholesterol in A. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002;106:3143-421.

  7. Jellinger PS, Smith DA, Mehta AE, et al. American Association of Clinical Endocrinologists' guidelines for management of dyslipidemia and prevention of atherosclerosis. Endocr Pract. 2012;18(suppl 1):1-78.
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#2
(09-12-2016, 05:42 PM)Dr. Sara Shamsuddini Wrote: It is recommended that individuals who meet any of the clinical risk criteria noted below should be screened for prediabetes or Type 2 diabetes. 

  • CVD or family history of T2D
  • Overweight or obese
  • Sedentary lifestyle
  • Member of an at-risk racial or ethnic group:
    • Asian
    • African American
    • Hispanic
    • Native American (Alaska Natives and American Indians)
    • Pacific Islander
  • High-density lipoprotein cholesterol (HDL-C) <35 mg/dL (0.90 mmol/L) and/or a triglyceride level >250 mg/dL (2.82 mmol/L)
  • Impaired glucose tolerance (IGT), impaired fasting glucose (IFG), and/or metabolic syndrome
  • Polycystic ovary syndrome (PCOS), acanthosis nigricans, or nonalcoholic fatty liver disease (NAFLD)
  • Hypertension (blood pressure >140/90 mm Hg or on antihypertensive therapy)
  • History of gestational diabetes or delivery of a baby weighing more than 4 kg (9 lb)
  • Antipsychotic therapy for schizophrenia and/or severe bipolar disease
  • Chronic glucocorticoid exposure
  • Sleep disorders in the presence of glucose intolerance (A1C >5.7%, IGT, or IFG on previous testing), including obstructive sleep apnea (OSA), chronic sleep deprivation, and night-shift occupation
[*]In the event of normal results, repeat testing at least every 3 years. Clinicians may consider annual screening for patients with 2 or more risk factors (1).
Medications and Prediabetes Risk 

Specific medications that increase prediabetes risk include:






  1. Antidepressants: The ongoing use of antidepressant medications may modestly increase the risk of developing prediabetes or T2D, although the elevation in absolute risk is modest (2).

  2. Psychotropic agents: Certain treatments for schizophrenia or bipolar disease may increase prediabetes, T2D, and/or CVD risk. Substantial weight gain has been associated with psychotropic agents, including some antipsychotic medications. These medications are also associated with adiposity-dependent and possibly adiposity-independent changes in insulin sensitivity and lipid metabolism (3). Among the second- and first-generation antipsychotics, respectively, clozapine and olanzapine and thioridazine and chlorpromazine have been associated with an increased risk of T2DM and dyslipidemia.










[*]Diagnostic Criteria 

A diagnosis of prediabetes should be made according to glucose criteria, although the metabolic syndrome is considered a prediabetes equivalent (1).

[*]
Glucose criteria. Glucose criteria for the diagnosis of prediabetes and diabetes appear in Table 1 (1,4). Prediabetes may be identified by the presence of impaired glucose tolerance (IGT; plasma glucose 140-199 mg/dL 2 hours after ingesting 75 g of glucose) and/or impaired fasting glucose (IFG; fasting glucose 100-125 mg/dL). A1C values between 5.5% and 6.4% inclusive should be a signal to do more specific glucose testing but should not be considered diagnostic. For prediabetes, A1C testing should be used only as a screening tool; FPG measurement or an oral glucose tolerance test (OGTT) should be used for definitive diagnosis.
[*]References


  1. Handelsman Y, Bloomgarden ZT, Grunberger G, et al. American Association of Clinical Endocrinologists and American College of Endocrinology: clinical practice guidelines for developing a diabetes mellitus comprehensive care plan—2015. Endocr Pract. 2015;21:1-87.

  2. Kivimaki M, Hamer M, Batty GD, et al. Antidepressant medication use, weight gain, and risk of type 2 diabetes: a population-based study. Diabetes Care. 2010;33:2611-2616.

  3. Newcomer JW. Antipsychotic medications: metabolic and cardiovascular risk. J Clin Psychiatry. 2007;68(suppl 4):8-13.

  4. Garber AJ, Handelsman Y, Einhorn D, et al. Diagnosis and management of prediabetes in the continuum of hyperglycemia: when do the risks of diabetes begin? A consensus statement from the American College of Endocrinology and the American Association of Clinical Endocrinologists. Endocr Pract. 2008;14:933-946.

  5. Lorenzo C, Williams K, Hunt KJ, Haffner SM. The National Cholesterol Education Program - Adult Treatment Panel III, International Diabetes Federation, and World Health Organization definitions of the metabolic syndrome as predictors of incident cardiovascular disease and diabetes. Diabetes Care. 2007;30:8-13.

  6. National Cholesterol Education Program Expert Panel on Detection E, Treatment of High Blood Cholesterol in A. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002;106:3143-421.

  7. Jellinger PS, Smith DA, Mehta AE, et al. American Association of Clinical Endocrinologists' guidelines for management of dyslipidemia and prevention of atherosclerosis. Endocr Pract. 2012;18(suppl 1):1-78.
[*]

Very informative article, tq
Reply
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