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IFG can eventually progress to type 2 diabetes mellitus without intervention, which typically involves lifestyle modification. Those with impaired fasting glucose have a 1. Some studies suggest that without lifestyle changes, IFG will progress to clinically diagnosable diabetes in just under 3 years, on average.
Impaired fasting glucose is often, though not always, associated with impaired glucose tolerance , though it may occur in isolation, with such persons having a normal response to a glucose tolerance test. Impaired fasting glucose is often without any signs or symptoms , other than higher than normal glucose levels being detected in an individual's fasting blood sample. There may be signs and symptoms associated with elevated blood glucose , though these are likely to be minor, with significant symptoms suggestive of complete progression to type 2 diabetes.
Such symptoms include: . As impaired fasting glucose is considered a precursor condition for type 2 diabetes, it shares the same environmental and genetic risk factors. Different organisations use slightly differing levels before classifying a person's fasting blood glucose as "impaired", with the American Diabetes Association using a lower cutoff in its criteria than the World Health Organization.
The upper limits remain the same, as fasting levels above this are almost universally accepted as indicative of full diabetes:. The guidelines for preventing impaired fasting glucose are the same as those given for preventing type 2 diabetes in general. If these are adhered to, the progression to clinical diabetes can be slowed or halted. In some cases, a complete reversal of IFG can be achieved. Certain risk factors, such as being of Afro-Caribbean or South Asian ethnicity, as well as increasing age, are unavoidable, and such individuals may be advised to follow these guidelines, as well as monitor their blood glucose levels, more closely.
From Wikipedia, the free encyclopedia. Impaired fasting glucose Other names Impaired fasting glycemia, IFG The fluctuation of blood sugar red and the sugar-lowering hormone insulin blue in humans during the course of a day with three meals. One of the effects of a sugar -rich vs a starch -rich meal is highlighted. Main article: Prevention of diabetes mellitus type 2. This section is empty.
You can help by adding to it. November The Adult Treatment Panel III of the National Cholesterol Education Program 13 has identified metabolic syndrome as a constellation of lipid and nonlipid risk factors for coronary artery disease. The syndrome is characterized by insulin resistance, atherogenic dyslipidemia high triglyceride level, low high-density lipoprotein cholesterol level, and small, dense low-density lipoprotein cholesterol particles , hypertension, abdominal obesity, and prothrombotic and proinflammatory states.
Metabolic syndrome is diagnosed when three or more of the risk factors in Table 2 13 are present. It is important for family physicians to identify patients with metabolic syndrome and to intervene aggressively to reduce the risk of diabetes and macrovascular disease. In a prospective study 14 conducted in Finland, cardiovascular disease and all-cause mortality were increased in men with metabolic syndrome even in the absence of cardiovascular disease and diabetes.
Women who have been diagnosed with gestational diabetes mellitus constitute another group at high risk for progression to diabetes. In a study of 1, women with recent gestational diabetes tested at one to four months postpartum, 14 percent were diagnosed with type 2 diabetes.
It is recommended that women diagnosed with gestational diabetes undergo postpartum glucose testing at six weeks and every three years thereafter. The American Academy of Family Physicians policy 16 on screening for type 2 diabetes is consistent with the U.
When these patients are specifically targeted for screening, the number needed to screen to prevent a cardiovascular event is lower than screening of the general population. The ADA acknowledges the lack of data from prospective studies on the benefits of screening for diabetes and therefore recommends using clinical judgment and patient preference as a guide.
Based on expert opinion, selective screening is recommended Table 3. The ADA also prefers to use the fasting plasma glucose level for screening, because it is faster, more acceptable to patients, and less expensive than other screening tests. The fasting plasma glucose level also is more reproducible than the g oral glucose tolerance test and varies less between patients. However, the g oral glucose tolerance test is more sensitive.
No data are available to assess possible harms of diabetes screening. Potential harms include labeling patients as having a chronic illness, which may cause anxiety and make it difficult for them to obtain life or health insurance, and subjecting patients to the risks of long-term treatment with uncertain benefits. The progression from normal glucose tolerance to type 2 diabetes is characterized by dual defects that include insulin resistance and an insulin secretory defect caused by beta-cell dysfunction Figure 1.
Initially, plasma glucose levels are maintained in the normal range. In patients who will eventually develop diabetes, there is a decline in beta-cell secretory capacity. The first glucose abnormality that is detected is a rise in the postprandial glucose levels because of reduced first-phase insulin secretion.
With time, further decline in beta-cell function leads to elevation of the fasting glucose levels. Eventually, diabetes occurs, with more insulin secretory loss. The natural history of type 2 diabetes. Implications for clinical practice. Prim Care ; Recent studies of patients with IGT have shown success for lifestyle interventions in delaying or preventing the development of diabetes Table 4.
Patients with IFG and IGT should be advised on the benefits of modest weight loss, good dietary habits, and regular physical activity. In the Diabetes Prevention Program, 1 3, patients with IGT and a BMI greater than 24 kg per m 2 were randomly assigned to one of the following groups: placebo, metformin Glucophage , or intensive lifestyle modification. The lifestyle modification group was offered a lesson curriculum aimed at achieving a weight loss goal of more than 7 percent of their initial body weight through a low-calorie, low-fat diet and moderate-intensity exercise for minutes per week.
Diabetes Prevention Program 1. Metformin Glucophage , mg twice daily. Finnish Diabetes Prevention Study 2. Diet plus exercise. Food and Drug Administration. Food and Drug Administration has withdrawn troglitazone from the market because of liver toxicity. Information from references 1 through 3 , and 21 through After an average follow-up of 2. The relative risk reduction was 31 percent in the metformin group compared with the placebo group. In this study, lifestyle intervention was effective in men and women, and in all ethnic groups.
It was most beneficial in patients older than 60 years; in this group, it reduced the incidence of diabetes by about 71 percent. Carbohydrates: 50 to 60 percent 2. Protein: 15 to 20 percent 3. Foods: salad, 3 vegetables, 3 fruits, whole grains, 24 fish high in omega-3 fatty acids, legumes, lean meat; minimal intake of refined sugars 3.
Counseling by professionals on weight reduction and exercise with regular follow-up and reinforcement 1 , 2. Information from references 1 through 3 , and Patients in the intervention group were instructed to lose 5 percent of their body weight, limit fat intake to less than 30 percent of daily calories, limit saturated fat intake to less than 10 percent of daily calories, increase fiber intake to at least 15 g per 1, calories, and exercise moderately for at least minutes a week.
After 3. There also was a significant positive correlation between the ability to achieve lifestyle modifications and preventing progression to diabetes. Over six years of follow-up, the relative risk reduction in progression to diabetes was 31 percent in the diet group, 46 percent in the exercise group, and 42 percent in the combined group. Although not as effective as lifestyle interventions, drug therapy with metformin and acarbose Precose has been shown to prevent the progression of IGT to diabetes.
Food and Drug Administration has withdrawn this drug from the market because of liver toxicity. In the Diabetes Prevention Program, treatment with metformin was associated with 31 percent relative reduction in the progression of diabetes in patients with IGT.
The incidence of diabetes increased in the group that originally had been treated with acarbose, indicating that this drug therapy must be continued to maintain preventive effects. Lifestyle interventions Table 5 1 — 3 , 24 can be difficult to implement because it is impractical for the usual family practice systems to provide intensive dietary and exercise interventions similar to those used in clinical trials. However, lifestyle interventions are highly effective and superior to drug therapy, and should be the first choice in treating patients with IGT or IFG.
Although pharmacologic agents have been shown to be successful in preventing or delaying the onset of diabetes, whether these agents can prevent complications of diabetes or protect against cardiovascular disease remains unknown. Routine use of pharmacologic agents as a substitute for lifestyle modification should be discouraged until more studies have been conducted and the cost-effectiveness of drug therapy has been assessed. A healthier lifestyle can modify other risk factors for cardiovascular disease such as obesity, hypertension, and dyslipidemia.
Drug therapy can be considered when aggressive lifestyle interventions are unsuccessful. The U. Preventive Services Task Force recommends screening fortype 2 diabetes in adults with hypertension or hyperlipidemia. There is strong evidence that a structured program of diet and exercisecan reduce the risk of progression to type 2 diabetes in patients with impaired glucose tolerance. Already a member or subscriber? Log in. He received his medical degree from Baylor College of Medicine, Houston, and completed a family practice residency at the University of Minnesota Methodist Hospital, St.
Louis Park. She also completed a master of biology degree at Southern Methodist University, Dallas. Address correspondence to Shobha S. Rao, M. Rao swmcdallas. Reprints are not available from the authors. The authors indicate that they do not have any conflicts of interest. Sources of funding: none reported. The authors thank Sandra Mulkey, R. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.
N Engl J Med. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. Diabetes Care. Prim Care. Capes S, Anand S.
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