Patients who are identified with prediabetes should be referred for education and lifestyle interventions to a qualified health professional (which may include clinician, dietitian, nursing staff and pharmacist).
Intensive lifestyle change or programs have been proven effective in delaying or preventing the onset of diabetes by about 50-58%. Effective lifestyle changes include setting achievable goals, obtaining weight loss when needed (between 5-10% of total body weight is recommended), and increasing physical activity to a minimum of 150 minutes per week (Tuomilehto, 2001).
- Patients with IGT, IFG or an A1c should be referred to an effective ongoing support program targeting weight loss of 7% of body weight and increasing physical activity to at least 150 minutes per week of moderate activity such as walking.
- Metformin therapy for prevention of T2DM may be considered in those patients meeting criteria for prediabetes.
- At least annual monitoring for the development of diabetes in those with prediabetes may be utilized.
- Screening for and treatment of modifiable risk factors for CVD are suggested.
Patients who respond to lifestyle interventions:
- Annual follow-up and reassessment of risks for developing diabetes (American Diabetes Association, 2014; Chiasson, 2002; Heart Outcomes Prevention Evaluation Study Investigators, The, 2002; Kelley, 2002; Eriksson, 1999)
Patients who are high risk and not responding to lifestyle interventions:
- Intensify education and counseling on lifestyle interventions. Lifestyle change remains the preferred method to prevent diabetes.
Health care clinicians should follow patients diagnosed with prediabetes on an annual basis to monitor his/her progress and review treatment goals (American Diabetes Association, 2014).