2. Screening for Prediabetes Kelly Moore, MD, FAAP IHS Division of Diabetes Treatment & Prevention

3. Overview Diagnosis of Prediabetes Screening Strategies Draft Core Elements for Screening Grantee Panel Discussion Questions/Discussion

4. Prediabetes  Definition Individuals with abnormal glucose regulation intermediate between the normal state and the state of diabetes Impaired Fasting Glucose (IFG) Impaired Glucose Tolerance (IGT) Importance of detection Each year, 10-28 percent develop diabetes Research: Lifestyle changes can reduce risk of developing diabetes

5. Prediabetes  Detection and treatment will also: Identify undiagnosed diabetes in some individuals Identify undiagnosed hypertension and undiagnosed dyslipidemias in some patients Lay the groundwork for healthy lifestyle changes

6. Stages in the natural history of diabetes NormalIGT Type 2 Diabetes Complications Disability Death Genetic Predisposition Preclinical StateClinical diseaseComplicationsDeath Disability Primary Prevention Secondary Prevention Tertiary Prevention

7. Diagnosis of Prediabetes  Classification and Tests Impaired Fasting Glucose (IFG) Fasting Blood Glucose (FBG)100 – 125 Impaired Glucose Tolerance (IGT) 2 hour Oral Glucose Tolerance Test (OGTT)140 - 199

8. Comparison of Test Results TestNormalPrediabetesDiabetes FBG (mg/dl) < 100100-125 (IFG) >125 OGTT – 2hr result (mg/dl) < 140140-199 (IGT) ≥ 200

9. Overlap of IGT and IFG Both IFG IGT

10. Screening for Prediabetes  Targeted vs. Universal Screening Targeted Screening more cost effective Universal Screening not routinely recommended Screen individuals 18 years and older with risk factors for Prediabetes or Metabolic Syndrome Overweight, Obesity Hypertension Low HDL, high TG Women with a history of GDM Family history of diabetes

11. Screening for Prediabetes  In practice, several strategies: Community settings Strategies include: Paper risk tests Fingerstick glucose tests Importance of Follow-up Clinical settings Random blood glucose Fasting blood glucose 2 hr Oral Glucose Tolerance Test

12. CGP Considerations  Eligibility for Intensive Activities Prediabetes – IFG, IGT Consistent with DPP, other studies Metabolic Syndrome – may consider eligibility later in demonstration project Screening Activities Opportunity to see what works, lessons learned Potential benefits for other Indian health programs

13. Core Element: Screening  Draft Protocol/Required Elements Developed in context of: IHS Prediabetes Guidelines Informal grantee input at previous meetings Discussion with technical experts IHS DDTP recommendations Target screening of individuals with risk factors Possible Settings for Screening Community Clinical Setting

14. Core Element: Screening  Community Screening Assessment of Risk Paper Risk Test, AND Fingerstick Glucose If either positive Refer to clinic OGTT – results include both FBG and 2 hr value FBG alone not enough – may miss some with undiagnosed diabetes Possible evaluation activity Compare use of paper risk test, fingerstick glucose, FBG, OGTT May result in lessons learned for other Indian health programs

15. Core Element: Screening  Outcomes of screening Normal results Education on risks for diabetes Prediabetes (IFG or IGT) Recruit to enter Intensive Activities Diabetes Refer to clinic for further care

16. Next Steps  Draft protocol/required activities Handout for binder Discuss with team  Grantee panel discussion Experience with screening for prediabetes  Questions/Discussion/Input All grant programs