Pre-Diabetes Must Be Treated, Doctors Urge

Diabetes experts created the first recommendations Tuesday for the treatment of people with pre-diabetes in the hopes of curbing the diabetes epidemic. There are now no solid guidelines for diagnosing and managing pre-diabetes, a condition in which a person's blood glucose levels are higher than normal but not high enough to be classified as diabetes.

If physicians do not recognize and treat pre-diabetes, diabetes will continue to inflate at great personal health and financial cost, says Daniel Einhorn, vice president of the American Association of Clinical Endocrinologists. The group is meeting in Oxon Hill, Md., near Washington, D.C.

In an early release of the new recommendations, members of the endocrinologist group agreed that diagnosing pre-diabetes should be based on more than the results of blood glucose tests, such as history of diabetes during pregnancy and family history of the disease. The group also decided that changes in ways of living, not medication, should be the first line of treatment in staving off diabetes.

"We, as endocrinologists, are saying we truly recognize a state of pre-diabetes, and I think the most important issue is that there is not one unifying point that defines it," Einhorn says.

The guidelines recommend that people with metabolic syndrome — defined by three or more of the following: elevated triglycerides, a low HDL (the so-called good cholesterol), a high fasting glucose, a big waist circumference and high blood pressure — be considered at high risk for pre-diabetes, as well as women with prior gestational diabetes, people with a family history of type 2 diabetes and obese patients.

"These people should all have their glucose tested," Einhorn says.

The new guidelines also advise that primary-care physicians and specialists address cardiovascular problems such as blood pressure and lipid levels when diagnosing pre-diabetes.

Though there was some debate at the conference over whether medication should be used to treat pre-diabetes, the final consensus is that certain drugs may have a place if diet and exercise do not bring down glucose levels first.

"This is a call to action to recognize that there are people at special risk and that not doing anything can lead to complications of the eyes, kidneys, nerves," Einhorn says.

David Marrero, director of the Diabetes Translational Research Center at Indiana University School of Medicine, says the guidelines are only the first step. "There is no quick fix. We need to give primary-care doctors tools to help patients with lifestyle modifications. Most doctors don't know how to deal with this and don't have the resources to help patients."

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