Clinical Recognition and Management of Patients with Prediabetes |
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| Institution: | 1. Department of Internal Medicine, Division of Community Internal Medicine, Mayo Clinic, Rochester, Minnesota;2. Department of Internal Medicine, Division of Endocrinology & Metabolism, Mayo Clinic, Rochester, Minnesota;3. Department of Internal Medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota;4. Department of Medicine and Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota;5. Center for Translational Informatics and Knowledge Management, Mayo Clinic, Rochester, Minnesota.;1. From Boston University School of Medicine/Boston Medical Center, Boston, Massachusetts.;2. Department of Endocrine and Metabolic Diseases, Rui-jin Hospital, Shanghai Jiao-tong University School of Medicine, Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai, China;3. Department of Pathology, Rui-jin Hospital, Shanghai Jiao-tong University School of Medicine, Shanghai, China;4. Department of Neurosurgery, Rui-jin Hospital, Shanghai Jiao-tong University School of Medicine, Shanghai, China;5. Department of Radiology, Rui-jin Hospital, Shanghai Jiao-tong University School of Medicine, Shanghai, China.;1. Subdireccion de Investigacion, Facultad de Medicina UANL, Calle Dr. Eduardo Aguirre Pequeño s/n, Colonia Mitras Centro, Monterrey, Nuevo León, México, C.P.64460 |
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| Abstract: | Objective: Early identification and management of prediabetes is critical to prevent progression to diabetes. We aimed to assess whether prediabetes is appropriately recognized and managed among patients with impaired fasting glucose (IFG).Methods: We carried out an observational study of Olmsted County residents evaluated at the Mayo Clinic between 1999–2017. We randomly selected 108 subjects with biochemical criteria of IFG and 105 normoglycemic subjects. We reviewed their health records at baseline (1999–2004) and during follow up (2005–2017) collecting demographic and clinical data including vitals, diagnoses, laboratory, and medications associated with cardiovascular comorbidities. The main outcome was documentation of any recognition of prediabetes and management recommendations (lifestyle changes and/or medications).Results: At baseline (1999–2004), 26.85% (29/108) of subjects with IFG were recognized as having prediabetes, and of these 75.86% (22/29) received management recommendations with 6.9% (2/29) getting metformin. During follow-up (2005–2017), 26.67% (28/105) of initial cohort of normoglycemic subjects developed incident IFG and of these, 85.71% (24/28) were recognized as having prediabetes, and 58.33% (14/24) received management recommendations. During the entire study period, 62.50% (85/136) were recognized as having prediabetes of which 75.29% (64/85) had documented management recommendations. High body mass index (BMI) (≥35) was associated with increased recognition (odds ratio [OR] 3.66; confidence interval [CI] 1.065, 12.500; P = .0395), and normal BMI (<25) was associated with a lack of recognition (OR 0.146; CI 0.189, 0.966; P = .0413).Conclusion: Despite evidence supporting the efficacy of lifestyle changes and medications in managing prediabetes, this condition is not fully recognized in routine clinical practice. Increased awareness of diagnostic criteria and appropriate management are essential to enhance diabetes prevention.Abbreviations: BMI = body mass index; CI = confidence interval; EHR = electronic health records; FBG = fasting blood glucose; IFG = impaired fasting glucose; IGT = impaired glucose tolerance; OR = odds ratio |
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