Prevalence

Prediabetes is a condition defined by the presence of impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) that has not yet reached the threshold for type 2 diabetes mellitus (T2D); the metabolic syndrome is also considered a prediabetes equivalent (1,2). Prediabetes raises short-term absolute risk of T2D by 3- to 10-fold (2). In the United States, 86 million people, or 37% of the US population, have prediabetes, and it is estimated that up to 70% of people with prediabetes may develop T2D during their lifetimes (3,4).

Screening for Prediabetes

AACE recommends that individuals who meet any of the clinical risk criteria noted below should be screened for prediabetes or type 2 diabetes (T2D) (1).

Obesity
Obesity is a neuroendocrine disease that is itself associated with numerous metabolic and biomechanical complications. It is generally defined as a body mass index (BMI) ≥30 kg/m², especially in the presence of obesity-related complications. In the context of prediabetes, obesity (1-3):

Epidemiology

Overall, type 1 diabetes (T1D) accounts for approximately 5% of diabetes and affects about 20 million individuals worldwide. Among those younger than 20 years of age, T1D accounts for the majority of T1D cases (1,2). The current U.S. prevalence estimate of 1-3 million T1D patients may triple by 2050 due to a rising incidence of T1D (3).

Type 1 diabetes (T1D) is a chronic autoimmune disorder that occurs in genetically susceptible individuals and that may be precipitated by environmental factors. In a susceptible individual, the immune system is triggered to develop an autoimmune response against altered pancreatic beta cell antigens, or molecules in beta cells that resemble a viral protein. Approximately 85% of T1D patients have circulating islet cell antibodies, and the majority of patients also have detectable anti-insulin antibodies.

Patients with type 1 diabetes (T1D) require exogenous insulin for survival and should be identified as soon as possible to avoid high morbidity due to a delay in insulin treatment.

Goals

The treatment goals for patients with type 1 diabetes (T1D) are the same as those for patients with type 2 diabetes (T2D), as outlined in Table 1 (1).

Table 1. Glucose goals for patients with diabetes (1).

Epidemiology

Diabetes affects 9.4% of the population of the United States, or approximately 30.3 million people. Of these, 7.2 million have not been diagnosed. Approximately 90% of all diabetes cases are type 2 diabetes.¹

Risk Factors

The risk factors for the development of both prediabetes and type 2 diabetes mellitus (T2DM) are as follows:¹

There is a continuum of risk for poor patient outcomes as glucose tolerance progresses from normal to overt type 2 diabetes. AACE-defined glucose tolerance categories are listed in Table 1.¹

Table 1. Glucose Testing and Interpretation¹

Optimal management of type 2 diabetes requires treatment of the “ABCs” of diabetes: A1C, blood pressure, and cholesterol (ie, dyslipidemia). This web page provides the rationale and targets for glucose management; AACE guidelines for blood pressure and lipid control are summarized in Management of Common Comorbidities of Diabetes.

Glucose Targets

The Comprehensive Care Plan

Every patient with documented type 2 diabetes (T2D) should have a comprehensive care plan (CCP), which takes into account the patient’s unique medical history, behaviors and risk factors, ethnocultural background, and environment. The ultimate goal of the CCP is to reduce the risk of diabetes complications without jeopardizing patient safety. To achieve this goal, the CCP should include the following components:¹

As may be expected with a chronic disease that primarily affects middle-aged and older individuals, type 2 diabetes is usually complicated by other medical conditions. In the 1999-2004 cohort of the National Health and Nutrition Examination Survey (NHANES), only 14% of patients with type 2 diabetes had no other comorbidities.¹ Here we briefly outline management recommendations for major comorbidities of patients diagnosed with diabetes—the management recommendations are the same whether patients have type 1 or type 2 diabetes mellitus (T1DM and T2DM).

Epidemiologic data have demonstrated significant increases of various cancers in people with obesity and diabetes. Recently, concern has emerged that antihyperglycemic medications may also be associated with an increased prevalence of multiple cancers; however, available data are limited and conflicting.^1,2

Comprehensive care of patients with diabetes requires a team of healthcare professionals. Working with different healthcare providers allows the patient to learn in-depth information regarding their health and well-being. It also ensures that the patient’s needs are cared for and addressed. It is important to use other providers’ skills and specialties to ensure patients have the best care and understanding of their condition. Often, problems may be apparent to one healthcare provider, but go unnoticed by another.

Epidemiology

Management of Pregnancy Complicated by Diabetes

Preconception Care

AACE guidelines specify that preconception care is important for all women with preexisting type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) or previous gestational diabetes mellitus (GDM). One of the primary goals of preconception care is to educate patients about strategies to maintain adequate nutrition and glu­cose control before conception, during pregnancy, and in the postpartum period.¹

Preconception Care

Prevalence

Prediabetes is a condition defined by the presence of impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) that has not yet reached the threshold for type 2 diabetes mellitus (T2D); the metabolic syndrome is also considered a prediabetes equivalent (1,2). Prediabetes raises short-term absolute risk of T2D by 3- to 10-fold (2). In the United States, 86 million people, or 37% of the US population, have prediabetes, and it is estimated that up to 70% of people with prediabetes may develop T2D during their lifetimes (3,4).

AACE recommends that individuals who meet any of the clinical risk criteria noted below should be screened for prediabetes or type 2 diabetes (T2D)¹.

Obesity 
Obesity is a neuroendocrine disease that is itself associated with numerous metabolic and biomechanical complications. It is generally defined as a body mass index (BMI) ≥30 kg/m², especially in the presence of obesity-related complications. In the context of prediabetes, obesity (1-3):

Treatment Goals 
The primary goal of prediabetes management is to normalize glucose levels and prevent or delay progression to diabetes and associated microvascular complications (1,2). Management of common prediabetes comorbidities such as obesity, hypertension, dyslipidemia, cardiovascular disease, and chronic kidney disease is also essential.

Epidemiology

Diabetes affects 9.4% of the population of the United States, or approximately 30.3 million people. Of these, 7.2 million have not been diagnosed. Approximately 90% of all diabetes cases are type 2 diabetes.¹

Type 1 diabetes (T1D) is a chronic autoimmune disorder that occurs in genetically susceptible individuals and that may be precipitated by environmental factors. In a susceptible individual, the immune system is triggered to develop an autoimmune response against altered pancreatic beta cell antigens, or molecules in beta cells that resemble a viral protein. Approximately 85% of T1D patients have circulating islet cell antibodies, and the majority of patients also have detectable anti-insulin antibodies.

Patients with type 1 diabetes (T1D) require exogenous insulin for survival and should be identified as soon as possible to avoid high morbidity due to a delay in insulin treatment.

Goals

• Utilize intensive therapy aimed at near-normal BG and A1C levels
• Prevent diabetic ketoacidosis and severe hypoglycemia
• Achieve the highest quality of life compatible with the daily demands of diabetes management
• In children, achieve normal growth and physical development and psychological maturation
• Establish realistic goals adapted to each individual’s circumstances

Risk Factors

The risk factors for the development of both prediabetes and type 2 diabetes mellitus (T2DM) are as follows:¹

There is a continuum of risk for poor patient outcomes as glucose tolerance progresses from normal to overt type 2 diabetes.

Optimal management of type 2 diabetes requires treatment of the “ABCs” of diabetes: A1C, blood pressure, and cholesterol (ie, dyslipidemia). This web page provides the rationale and targets for glucose management; AACE guidelines for blood pressure and lipid control are summarized in Management of Common Comorbidities of Diabetes.

The Comprehensive Care Plan

Every patient with documented type 2 diabetes (T2D) should have a comprehensive care plan (CCP), which takes into account the patient’s unique medical history, behaviors and risk factors, ethnocultural background, and environment. The ultimate goal of the CCP is to reduce the risk of diabetes complications without jeopardizing patient safety. To achieve this goal, the CCP should include the following components:¹

As may be expected with a chronic disease that primarily affects middle-aged and older individuals, type 2 diabetes is usually complicated by other medical conditions. In the 1999-2004 cohort of the National Health and Nutrition Examination Survey (NHANES), only 14% of patients with type 2 diabetes had no other comorbidities.¹Here we briefly outline management recommendations for major comorbidities of patients diagnosed with diabetes—the management recommendations are the same whether patients have type 1 or type 2 diabetes mellitus (T1DM and T2DM).

Epidemiologic data have demonstrated significant increases of various cancers in people with obesity and diabetes. Recently, concern has emerged that antihyperglycemic medications may also be associated with an increased prevalence of multiple cancers; however, available data are limited and conflicting.^1,2

Epidemiology

Three types of diabetes may complicate pregnancy: preexisting type 1 diabetes mellitus (T1DM), type 2 diabetes mellitus (T2DM), or gestational diabetes mellitus (GDM). By definition, the first two types of diabetes are already established prior to pregnancy. GDM, also referred to as hyperglycemia in pregnancy, is a condition in which glucose intolerance develops in a patient who has not been previously diagnosed with diabetes.^1,2

GDM Definition, Etiology, Risk Factors, and Pathophysiology

Definition

Gestational diabetes mellitus (GDM) has been defined as any degree of carbohydrate intolerance with onset during pregnancy. This definition is a misnomer in that it includes unrecognized overt diabetes that may have been present prior to pregnancy as well as hyperglycemia that develops during pregnancy. Preexisting type 2 diabetes can often present as severe hyperglycemia during pregnancy.

Preconception Care

AACE guidelines specify that preconception care is important for all women with preexisting type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) or previous gestational diabetes mellitus (GDM). One of the primary goals of preconception care is to educate patients about strategies to maintain adequate nutrition and glu­cose control before conception, during pregnancy, and in the postpartum period.¹