Tuesday, August 24, 2021

More Rigid Criteria for Prediabetes May Be in Order in the National Diabetes Prevention Program

To delay or prevent type 2 diabetes, the CDC’s National Diabetes Prevention Program Lifestyle Change Program (National DPP LCP) treats individuals with prediabetes. Prediabetes is a condition where a person's blood glucose is elevated, but not elevated enough to be called diabetes. Prediabetes is often a precursor to type 2 diabetes. The prediabetes criteria used by the National DPP to admit persons into its prevention program are the same criteria used by the American Diabetes Association (ADA) and the CDC. However, those criteria allow individuals into the program who may be at a very low risk of contracting type 2 diabetes. So, looking at the probability of contracting diabetes at different points in the ADA's prediabetes criteria range may be beneficial. And one study has done the analysis.

The ADA uses the following criteria for prediabetes: a fasting plasma glucose (FPG) greater than or equal to 100 mg/dL and less than or equal to 125 mg/dL; an impaired glucose tolerance (IGT) where the glucose is greater than or equal to 140 mg/dL and less than or equal to 200 mg/dL; and an HbA1c greater than or equal to 5.7% and less than or equal to 6.4%.

The study mentioned above was done in Spain. There were 1184 participants in the study. And the participants in the study group satisfied two of the ADA's prediabetes criteria. These criteria were FPG between 100 mg/dL and 125 mg/dL and  HbA1c between 5.7% and 6.4%. The mean follow-up for the group was 4.2 years.

The researchers found that individuals at the lower ends of the prediabetes criteria ranges had a lower probability of advancing to type 2 diabetes. Specifically, the researchers stated that "The lowest incidence rate of diabetes was observed in the prediabetes category for isolated FPG 100–109 mg/dL; and the highest, in individuals with FPG within 110–125 mg/dL plus HbA1c 6.0–6.4%. As for reversion to normoglycemia, the highest rate was in the group with isolated HbA1c 5.7–5.9%, and the lowest in the category with FPG 110–125 mg/dL plus HbA1c 6.0–6.4%."

Therefore, focusing on individuals with prediabetes at the higher levels of blood glucose within the ADA's prediabetes criteria ranges may be a better use of resources.





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