Identifying the Target Population for Primary Prevention
The Trade-Offs
- Michael M Engelgau, MD,
- K.M. Venkat Narayan, MD and
- Frank Vinicor, MD
- From The Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Compelling evidence now exists that type 2 diabetes can be prevented or delayed in subjects with impaired glucose tolerance (IGT) (2-h oral glucose tolerance test [OGTT] 140–199 mg/dl) (1–4), a group at great risk for subsequent diabetes and cardiovascular disease (5,6). This evidence has held consistently across different populations, in different countries, among men and women, and in all age and racial and ethnic groups. Based on these studies, national health organizations, including those in the U.S. and Finland, are now calling for action (7,8). The American Diabetes Association (ADA) has recommended to consider clinic-based (opportunistic) screening for prediabetes (impaired fasting glucose [IFG] 110–125 mg/dl or IGT) among persons aged >45 years and among younger persons with other diabetes risk factors; they strongly recommend opportunistic screening in persons aged >45 years with BMI ≥25 kg/m2 (7). Approximately one-third of individuals with either IFG or IGT and two-thirds of individuals with both will develop extant diabetes within 6 years (5). However, at present we know little about validated strategies to detect prediabetes in the “real world.” Using fasting, random, and postprandial glucose measurements or A1C levels are options. Anecdotally, performing glucose challenges is cumbersome, difficult, more costly, time consuming, and less acceptable to both patients and health care providers than fasting glucose or A1C measurements. Thus, our first clinical and public health challenge for primary prevention is clear: how are we going to find people with prediabetes?
The study of Saydah et al. …
