Impaired Fasting Glucose and Impaired Glucose Tolerance

Nathan, David M.; Davidson, Mayer B.; DeFronzo, Ralph A.; Heine, Robert J.; Henry, Robert R.; Pratley, Richard E.; Zinman, Bernard

doi:10.2337/dc07-9920

Cited by 1,200 publications

(965 citation statements)

References 54 publications

Supporting

Mentioning

906

Contrasting

Unclassified

Order By: Relevance

“…The evidence for metformin use is strongest for patients younger than 60 years, those with a BMI greater than 35 kg/m 2 , or those with a history of gestational diabetes (13). Expert panels have also advocated that metformin use be considered in patients with an impaired fasting glucose level and impaired glucose tolerance if they also have a family history of diabetes in first-degree relatives, elevated triglyceride levels, reduced high-density lipoprotein cholesterol levels, hypertension, or more severe or progressive hyperglycemia (either a hemoglobin A 1c level >6.0% or progression of an underlying disease, as evidenced by an increase in fasting plasma glucose, hemoglobin A 1c , or 2-hour postprandial glucose level) (30). Potential strategies to increase awareness and promote informed decision making among this at-risk population could include clinical decision-making tools, physiciandirected and performance-based incentive programs, or media campaigns to increase public awareness of prediabetes and its consequences if left untreated.…”

Section: Discussionmentioning

confidence: 99%

“…Third, our analysis focused on commercially insured adults and may not be generalizable to uninsured or older patients. However, our focus on working-age adults is important because prediabetes affects more than 1 in 3 adults older than 20 years and the evidence for metformin use is strongest for those younger than 60 years (3,6,30). Last, our definition of eligible patients differed from the definition in the American Diabetes Association national guidelines (13).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Metformin Prescription for Insured Adults With Prediabetes From 2010 to 2012

2015

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Metformin Prescription for Insured Adults With Prediabetes From 2010 to 2012

2015

View full text Add to dashboard Cite

“…7 Awareness of the prediabetic states impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) is also important because lifestyle modification may delay or prevent the progression to diabetes and its associated complications, such as cardiovascular disease, retinopathy, and nephropathy. 10,11 In the inpatient setting, undiagnosed elevation of Hgb A 1C in the diabetes or prediabetes range has been shown to increase cost and length of stay in some spine surgery patients compared to patients with known diabetes. 12 Virtually every inpatient has at least 1 glucose value drawn during hospitalization as part of a chemistry panel, many of which are fasting, or ''NPO'' (''nil per os'', meaning nothing by mouth), by virtue of clinical condition or anticipated procedure.…”

Section: Objectivementioning

confidence: 99%

Preoperative “NPO” as an opportunity for diabetes screening

Sheehy¹,

Benca

Glinberg

et al. 2012

Journal of Hospital Medicine

View full text Add to dashboard Cite

BACKGROUND:Novel preventive care opportunities, such as in hospitalized patients, may merit further investigation in an Accountable Care Organization (ACO) model. As 40% of patients with diabetes are undiagnosed, diabetes screening is an urgent public health need. Screening fasting preoperative patients may present an effective means to identify patients who might otherwise remain undiagnosed.OBJECTIVE:To pilot an inpatient preventive care strategy for diabetes screening that would ascertain prevalence of unrecognized inpatient diabetes (DM) and impaired fasting glucose (IFG), determine reproducibility of preoperative fasting blood glucose (FBG), and establish feasibility of inpatient preventive screening.DESIGN:Prospective observational study.SETTING:Large Midwestern academic medical center.PATIENTS:Two hundred seventy‐five elective orthopedic patients with a preoperative visit between December 1, 2007 and November 30, 2008. Most patients (96.6%) had seen their primary care provider (PCP) within 12 months, and 100% were insured.MEASUREMENTS:Medical history was recorded, and hemoglobin A1C (Hgb A1C) and FBG were drawn immediately prior to surgery. Patients with preoperative FBG ≥100 mg/dL had FBG drawn 6–8 weeks postoperatively.RESULTS:Twenty‐four percent (67/275) of patients had previously unrecognized DM or IFG by virtue of 2 abnormal values. Sixty‐four percent of patients with FBG ≥100 mg/dL preoperatively remained elevated at ambulatory follow‐up. No patients with new DM or IFG had point‐of‐care glucose checks ordered or had dysglycemia mentioned on discharge summary.CONCLUSIONS:Inpatient undiagnosed DM and IFG is common, even in insured, elective surgery patients with recent primary care visits. Preoperative FBG can be used to screen, but results need to be conveyed to PCPs. Journal of Hospital Medicine 2012; © 2012 Society of Hospital Medicine

show abstract

“…More recently, a new category of impaired glucose regulation (IGR, in WHO terms [9]) was introduced to obviate the investment in OGTT screening, namely impaired fasting glucose (IFG), defined as fasting plasma glucose between 6.1 and 7.0 mmol/l. While clearly a risk condition for type 2 diabetes, IFG is believed to have a partially different pathophysiological basis to that of IGT, being characterised by hepatic rather than peripheral insulin resistance and by more marked beta cell dysfunction [10]. Before this definition was widely accepted, it was changed and the lower threshold for fasting glycaemia lowered to 5.6 mmol/l [11].…”

mentioning

confidence: 99%

Plasma glucose levels as predictors of diabetes: the Mexico City diabetes study

Ferrannini

Massari²,

Nannipieri

et al. 2009

Diabetologia

View full text Add to dashboard Cite

Aims/hypothesis The value of diagnostic categories of glucose intolerance for predicting type 2 diabetes is much debated. We therefore sought to estimate relative and population-attributable risk of different definitions based on fasting (impaired fasting glucose [IFG]) or 2 h plasma glucose concentrations (impaired glucose tolerance [IGT]) and to describe the associated clinical phenotypes. Methods We prospectively observed a population-based cohort of 1,963 non-diabetic participants (mean age 47 years), in whom an OGTT was performed at baseline and 7 years later. Results IGT was fivefold more prevalent (13.5%) than IFG. In both categories, participants were older, heavier, hyperinsulinaemic, hyperproinsulinaemic and dyslipidaemic compared with participants with normal glucose tolerance. Relative risk of incident diabetes was similar for IFG and IGT categories (3.73 [95% CI: 2.18-6.39] and 4.01 [95% CI: 3.12-5.14], respectively), but the population-attributable risk was fivefold higher for IGT (29% [95% CI: 26-32]) than for IFG (6% [95% CI: 5-7]). Isolated IFG carried no increase in risk. Lowering the threshold to 5.6 mmol/l raised the population-attributable risk of IFG to 23% (95% CI: 20-25); its contribution to diabetes progression, however, was largely due to co-existent IGT. In multivariate analysis adjusting for sex, age, familial diabetes and BMI, fasting and 2 h glucose were independent predictors. Conclusions/interpretation Fasting and 2 h glucose values are independent predictors of incident diabetes. Isolated IFG is not a high-risk condition; lowering the diagnostic threshold increases the population-attributable risk of IFG fourfold, but performing an OGTT captures additional diabetes progressors compared with the number identified by IFG.

show abstract

Impaired Fasting Glucose and Impaired Glucose Tolerance

Cited by 1,200 publications

References 54 publications

Metformin Prescription for Insured Adults With Prediabetes From 2010 to 2012

Metformin Prescription for Insured Adults With Prediabetes From 2010 to 2012

Preoperative “NPO” as an opportunity for diabetes screening

Plasma glucose levels as predictors of diabetes: the Mexico City diabetes study

Contact Info

Product

Resources

About