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Diabetes Prevention
The Importance of Testing for Pre-diabetes—Using the Right Tool
Olga S Chajewski, MD
1
and James H Nichols, PhD, DABCC, FACB
2
1. Pathology Resident, Baystate Medical Center; 2. Professor of Pathology, Tufts University School of Medicine, and
Medical Director, Clinical Chemistry, Department of Pathology, Baystate Health System
Abstract
Diabetes is one of the most prevalent chronic diseases affecting the US healthcare system today, and increasing emphasis is being placed on
disease prevention and screening. Early detection of pre-diabetes can be of great benefit to patients as studies have shown that signs of early
diabetic complications often exist at the time of diagnosis. Early intervention has been shown to delay, and in some cases prevent, the
progression from pre-diabetes to diabetes. Venous blood sampling and core laboratory analysis remain the gold standard for diagnosis. While
point-of-care testing (POCT) devices are convenient and readily available, many variables affect the technical performance of POCT devices to
allow their use as a reliable diagnostic method. Future diagnostic techniques may include glycated hemoglobin (HbA
1c
) testing or genotyping
and antibody screening. Currently, the HbA
1c
assay is used in the monitoring of diabetes, but its potential for diagnosis of diabetes is currently
being examined. Genotyping and antibody screening for type 1 diabetes are showing promise as they add to the understanding of type 2
diabetes. However, this research is still in the early stages and is not yet available for clinical use.
Keywords
Pre-diabetes, fasting plasma glucose (FPG), impaired fasting glucose (IFG), impaired glucose tolerance (IGT), oral glucose tolerance test (OGTT),
point-of-care testing (POCT)
Disclosure: The authors have no conflicts of interest to declare.
Received: October 1, 2009 Accepted: December 7, 2009
Correspondence: James H Nichols, PhD, DABCC, FACB, Professor of Pathology, Tufts University School of Medicine, Medical Director, Clinical Chemistry, Baystate Health,
759 Chestnut Street, Springfield, MA 01199. E: james.nichols@baystatehealth.org
Type 2 diabetes, formerly referred to as non-insulin-dependent or Pre-diabetes can be thought of as an intermediate stage along a
adult-onset diabetes, is a chronic medical condition caused by insulin spectrum between normal glucose and frank hyperglycemic plasma
resistance, inadequate insulin secretion, or a combination of both.
1
It levels.
2
It represents a subset of patients who are found to have
differs from type 1 diabetes in that it can be acquired due to a impaired fasting glucose (IFG), impaired glucose tolerance (IGT), or both.
multitude of lifestyle and medical factors rather than being caused by The progression from pre-diabetes to type 2 diabetes occurs over many
the autoimmune destruction of insulin-secreting beta cells in the years, but the pre-diabetic state is not without risk. Pre-diabetes itself
pancreas. The influence of lifestyle on the development of type 2 presents increased risk for development of microvascular and
diabetes makes it the most common form of diabetes in developed macrovascular diseases and their complications,
2
and is also a risk
countries.
1
The annual cost of diabetes care in the US approaches factor for future development of type 2 diabetes. By identifying patients
$100 billion, including both acute conditions and long-term with pre-diabetes and initiating early interventions—lifestyle and/or
complications of diabetes. pharmacological—the progression to type 2 diabetes can be delayed,
or in some cases even prevented.
As healthcare costs rise, there has been an increased emphasis on
disease prevention. Prevention strategies have led to screening Type 2 diabetes is diagnosed by either random fasting plasma glucose
recommendations for various conditions, including colon and breast (FPG) levels or oral glucose tolerance testing (OGTT) in the physician’s
cancer, with minimally invasive techniques such as occult blood testing office. As it is not feasible to test the entire population, currently only
and breast exams, respectively. Diabetes, which is currently one of the individuals at high risk for developing type 2 diabetes are screened with
foremost chronic diseases worldwide, should be approached no blood tests. These include patients with a family history of diabetes or a
differently. The American Diabetes Association (ADA), the World Health personal history of hypertension, dyslipidemia, or cardiovascular disease,
Organization (WHO), and various international organizations have made or those belonging to certain ethnic groups known to have a higher risk,
efforts to increase screening for type 2 diabetes with corresponding such as African-Americans.
3
Of the two blood tests, studies have shown
lifestyle, dietary, and drug interventions. that the OGTT detects pre-diabetes more reliably than FPG levels.
3–5
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