Building Competency in Diabetes Education THE ESSENTIALS

3-16 | CHAPTER 3

unhealthy eating. The exact mechanism of susceptibility to type 2 diabetes by these genes is unclear.

Prediabetes The term prediabetes includes IFG and IGT, and it reflects the progressive nature of type 2 diabetes. People with prediabetes are not at increased risk for microvascular disease, however, they have an increased risk of developing diabetes and its complications, especially cardiovascular disease (CVD) (1). Persons with IGT are at greater risk for CVD than those persons with IFG; a patient may have both IFG and IGT (1). There is a 100% increased risk of developing type 2 diabetes over a five-year period when the FPG is between 6.1 and 6.9 mmol/L and if the glycated hemoglobin (A1C) is 6.0% to 6.4% (26).

Table 2. Diagnosis of prediabetes Test

Result

Prediabetes category

FPG (mmol/L)

6.1 - 6.9

IFG

2hPG in a 75 g OGTT (mmol/L)

7.8 – 11.0

IGT

A1C (%) Prediabetes 2hPG = 2-hour plasma glucose; IFG = impaired fasting glucose; A1C = glycated hemoglobin; IGT = impaired glucose tolerance; FPG = fasting plasma glucose; OGTT- oral glucose tolerance test Adapted from Diabetes Canada 2018 Clinical Practice Guidelines (1) Considering progressive worsening of glucose homeostasis, Monnier used 24-hour continuous glucose monitoring to demonstrate that postprandial glucose levels deteriorate first, followed by pre- and post-breakfast morning levels (corresponding to a dawn and extended dawn effect). The third step is sustained nocturnal hyperglycemia with increased fasting glucose (27). Patients in prediabetes state should be targeted for risk reduction strategies. Participants in intensive lifestyle modification programs have successfully delayed the onset of diabetes for at least three years (28). Implementing a structured lifestyle modification program (a reduction in caloric and fat intake, along with increased moderate-intensity physical activity of at least 150 minutes a week) can reduce weight by 5% and slow progression to diabetes by 58% (28). 6.0 – 6.4