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6. Diabetes prevention in patients
with intermediate hyperglycaemia
The questions to be answered are:
• Which interventions are effective to prevent the development of diabetes in patients with
impaired fasting glucose or intolerance to glucose (diet, exercise, pharmacological treatment)?
Intermediate hyperglycaemias (or pre-diabetic stages) refer to two concepts,
Impaired Fasting Glucose (IFG) and Impaired Glucose Tolerance (IGT), which
overlap and whose definition has changed a lot in the last years, depending on the
levels selected to define normoglycaemia.
Both the American Diabetes Association, the WHO and the IDF (International
Diabetes Federation) establish a category of hyperglycaemic stages between glycemic
normality and the diagnose of diabetes by the determination of fasting plasma
glucose (FPG or the venous plasma glucose considering the 75 g OGTT after
two hours.
These organizations differ in the level of fasting plasma glucosethat is considered
impaired fasting glucose (see table 3). A broad and thorough SR on the
diagnostic and prognostic implications of impaired fasting glucose and impaired
glucose tolerance (70) has been published recently. This report uses the WHO and
IDF criteria, so these are the criteria adopted in this CPG.
The criteria are as follows:
Table 3. Diabetes and intermediate glycaemia diagnostic criteria (WHO and IDF)
Basal Glycaemia 2 h- OGTT Glycaemia at random
Normal 126 mg/dl ≥200 mg/dl ≥200 mg/dl
* ADA considers impaired fasting glucose between 100-125 mg/dl. The determinations are carried out in venous plasma.
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