The American Diabetes Association has recently published their new 2007 standards of medical care for patients with diabetes. It is recommended that testing for diabetes should be considered for all individuals at age 45 and above, especially for those with a BMI of 25 or higher. If normal, it should be repeated every 3 years. Testing should be done at a younger age or more frequently for people who are overweight (BMI over 25) and who have additional risk factors such as physical inactivity, first-degree relatives with diabetes, or are members of a high-risk ethnic group such as Native American, African American, or Latino American. The diagnosis of diabetes is made if someone has symptoms of diabetes and a casual plasma glucose of 200 mg/dl or higher or a fasting plasma glucose of 126 mg/dl or higher or a 2-hour plasma glucose of 200 mg/dl or higher during an oral glucose tolerance test. Casual is defined as any time of day without regard to time since the last meal. Fasting is defined as at least 8 hours without any caloric intake. Screening is also recommended for similar groups that do not exhibit symptoms of diabetes. Type 2 diabetes is often not diagnosed until complications arise. Up to one-third of all people with type 2 diabetes may be undiagnosed. It is for this reason that screening is recommended for people at risk who do not yet exhibit symptoms.

Recommendations to prevent or delay type 2 diabetes include increasing awareness of the benefits of modest weight loss and regular physical activity, importance of initial and follow-up counseling, monitoring for the development of diabetes should be done every 1 or 2 years for those described as pre-diabetic (metabolic syndrome), and reducing or eliminating other cardio-vascular disease risk factors such as smoking, high blood pressure, or elevated cholesterol levels.

One of the points of emphasis for the prevention of diabetes is the importance of lifestyle modification. Although substantial efforts are necessary to achieve only modest changes in weight (7% weight loss or more), these changes were sufficient to achieve important reductions in the incidence of diabetes. Health care professionals are encouraged to counsel patients to maintain a normal body weight and to exercise regularly. Diet control using medical nutrition therapy (MNT), an individualized approach to selecting food choices that optimizes desired diabetes outcomes rather than the ADA diet is recommended. Because of potential side effects and cost, medications are not recommended for the prevention of diabetes.

Upon the diagnosis of diabetes, a complete management plan should be formulated by the physician-led care team. This plan should include regular blood glucose monitoring to determine glucose control. A1C testing should be used to assess treatment effectiveness. A1C reflects mean glycemic levels over the past 2 to 3 months. The goals of treatment are to achieve A1C levels as close to normal as possible (less than 6%).

A consensus statement has been issued by the ADA and the European Association for the Study of Diabetes that recommends early treatment with metformin combined with lifestyle modification with continuing augmentation of therapy with additional agents (including early use of insulin) to achieve and maintain recommended levels of glycemic control which is A1C less than 7% for most patients.

Reference: http://care.diabetesjournals.org/cgi/content/full/30/suppl_1/S4#T7.

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