Medicosnext
1. Screen
2. Assess and advice
3. Follow up
4. Evaluate
Screen
1. Ask patient to take ADA risk test
2. Find out who might have risk factor
3. Be proactive in an effort to improve outcome
4. Depending upon results, invite them to be tested
5. If diagnosed with diabetes or prediabetes,
6. Assess and advice, follow up, and evaluate
Criteria for screening for prediabetes in asymptomatic adults
Diabetic risk factor
1. Consider testing all adults with BMI>25 KG/M2 and additional risk factors. If no risk factor, consider screening no later than age of 45 years.
2. If normal results, repeat testing at 3 years interval. More frequently depending upon initial test results and risk factor.
Test yearly if prediabetes
• Physical inactivity
• First degree relative with diabetes
• High risk-race/ethnicity
• Women who deliver a baby weighing>9 lb or were diagnosed with GDM
• Hypertension(>140/90 mm/hg or on therapy for htn
• HDL-C>35mg/dl or TG>250mg/dl
• A1c>5.7%.IGT,or IGF on previous testing
• Other clinical conditions associated with insulin resistance
• History of CVD
• Modifiable risk factor of prediabetes for CV disease
• Non modifiable- age race/ethnicity, gender, family history
• Modifiable- physical inactive, overweight/obesity, hypertension, smoking, abnormal lipid metabolism
Screening for children for prediabetes
Consider for all children who are overweight and have 2 of any following risk factors
• Family history of t2dm in first and second degree relative
• High risk race/ ethnicity
• Signs if insulin resistance or conditions associated with insulin resistance
• Maternal history of diabetes of GDM during child’s gestations
• Begin screening at age of 10 years or onset of puberty
• Screen every2- 3 years
• A1C is recommended for diagnosis in children
Assessing patients with prediabetes
1. What does the patient already know
2. What does the patient want to know
3. What is of concern to the patient
4. Desired level of information
5. Evaluate the spectrum of predisposing risk factors
6. Involve them in developing a management strategy, especially changes in lifestyle-weight loss, increase activity, healthy eating
Steps of achieving treatment goals
• Assess
• Generate goals
• Record
• Evaluate
• Empower focus on developing specific goals
• Let the patient take the lead keep goals
o Few in number
o Individualized
o Realistic
o Measurable- frequency and duration
