A Proactive Approach to Type 2 Diabetes

Saturday, October 11, 2014 at 4:15 pm

LAS VEGAS—Statistics show that 3 years ago, only 7% of patients with prediabetes knew they had it. Yet, this serious medical condition affects more than 85 million Americans and continues to increase in prevalence.  

In their presentation, “Foundations in Type 2 Diabetes,” yesterday afternoon, Daniel Einhorn, MD, and John E. Anderson, MD, encouraged attendees to strike while the iron is hot.

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“When the patient’s attention is definitely focused on the word ‘diabetes,’ it offers a ‘teachable moment,’” said Einhorn, immediate-past president of the American College of Endocrinology and medical director of the Scripps Whittier Diabetes Institute in San Diego. “This is the time to reinforce messaging about fitness and weight, control of blood pressure and cholesterol, and the possibility of generic medication, metformin, to prevent progression to diabetes.”

The presenters emphasized that early intervention is easier on patients and their families and is most effective at preventing the otherwise debilitating consequences of uncontrolled diabetes over the years. They focused on early identification of patients at risk for diabetes and adopting measures to prevent or delay the onset of type 2 diabetes.

“There are no symptoms to warn the patient or the practitioner—diagnosis [of prediabetes] requires a high index of suspicion based upon risk factors such as abdominal obesity, hypertriglyceridemia, hypertension, and family history of diabetes, etc,” Einhorn said.

The only way to make the diagnosis is by a glycemia lab test, such as fasting blood glucose (100 mg/dL to 125 mg/dL), 2-hour post-challenge glucose (150 mg/dL to 199 mg/dL), or A1c (5.7% to 6.4%).

What should primary care providers do once a diagnosis has been made? Talk with patients about what this diagnosis means and what it will mean for them, and engage them in the prevention process as quickly as possible.

“The focus from the primary care provider should center on managing all aspects of cardiovascular risk in these patients, including blood pressure and lipids,” said Anderson, an internist at the Frist Clinic in Nashville. “The key for the treatment team is to focus on lifestyle interventions that can produce a 5% to 7% weight loss as demonstrated in the Diabetes Prevention Program.”

The Diabetes Prevention Program also showed that prevention or delay of type 2 diabetes can be achieved with identification and treatment of prediabetes. If and when it does progress to diabetes, early intervention is crucial. A number of large clinical trials have suggested that the early management of type 2 diabetes can produce long-term benefits if glycemic control is optimized.

“All of these interventions can produce cost savings as well reducing complications from the disease,” Anderson said. “The problem, however, is more complex, in that social, economic, and other factors in society also need to be addressed in order to impact this epidemic.”   

—Colleen Mullarkey