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1、ENDOCRINE PRACTICE Vol 14 No. 7 October 2008 933 DIAgNOsIs AND MANAgEMENT Of PREDIAbETEs IN ThE CONTINuuM Of hyPERglyCEMIAWhEN DO ThE RIsks Of DIAbETEs bEgIN? A CONsENsus sTATEMENT fROM ThE AMERICAN COllEgE Of ENDOCRINOlOgy AND ThE AMERICAN AssOCIATION Of ClINICAl ENDOCRINOlOgIsTs* Alan J. Garber, M
2、D, PhD, FACE, Yehuda Handelsman, MD, FACP, FACE, Daniel Einhorn, MD, FACP, FACE, Donald A. Bergman, MD, FACE, Zachary T. Bloomgarden, MD, FACE, Vivian Fonseca, MD, FACE, W. Timothy Garvey, MD, James R. Gavin III, MD, PhD, George Grunberger, MD, FACP, FACE, Edward S. Horton, MD, FACE, Paul S. Jelling
3、er, MD, MACE, Kenneth L. Jones, MD, Harold Lebovitz, MD, FACE, Philip Levy, MD, MACE, Darren K. McGuire, MD, MHSc, FACC, Etie S. Moghissi, MD, FACP, FACE, and Richard W. Nesto, MD, FACC, FAHA*Based on a consensus conference held in Washington, DC, on July 21 and 22, 2008. 2008 by the American Colleg
4、e of Endocrinology and the American Association of Clinical EndocrinologistsACE/AACE Consensus Statement934 Prediabetes Consensus statement, Endocr Pract. 2008;14(No. 7)TASk ForCE Alan J. Garber, MD, PhD, FACE; Chair Yehuda Handelsman, MD, FACP, FACE; Co Chair Daniel Einhorn, MD, FACP, FACE; Co Chai
5、rMembersDonald A. Bergman, MD, FACE Edward S. Horton, MD, FACE James R. Gavin III, MD, PhD George Grunberger, MD, FACP, FACE Paul S. Jellinger, MD, MACE Harold Lebovitz, MD, FACE Philip Levy, MD, MACE Etie S. Moghissi, MD, FACP, FACEWriting PanelAlan J. Garber, MD, PhD, FACE Yehuda Handelsman, MD, F
6、ACP, FACE Daniel Einhorn, MD, FACP, FACE Donald A. Bergman, MD, FACE Zachary T. Bloomgarden, MD, FACE Vivian Fonseca, MD, FACE W. Timothy Garvey, MD James R. Gavin III, MD, PhD George Grunberger, MD, FACP, FACE Edward S. Horton, MD, FACE Paul S. Jellinger, MD, MACE Kenneth L. Jones, MD Harold Lebovi
7、tz, MD, FACE Philip Levy, MD, MACE Darren K. McGuire, MD, MHSc, FACC Etie S. Moghissi, MD, FACP, FACE Richard W. Nesto, MD, FACC, FAHAMedical WriterKate Mann, PharmDSponsorsAmerican College of Endocrinology American Association of Clinical EndocrinologistsPrediabetes Consensus statement, Endocr Prac
8、t. 2008;14(No. 7) 935 Abbreviations: AACE = American Association of Clinical Endocrinologists; ACE = American College of Endocrinology; CVD = cardiovascular disease; IFG = impaired fasting glucose; IGT = impaired glucose tolerance; NCEP = National Cholesterol Education Program; QALY = quality-adjust
9、ed life-year INTRODUCTIONA worldwide pandemic of obesity and diabetes is well advanced. In the United States alone, diabetes now affects an estimated 24.1 million people, an increase of more than 3 million in approximately 2 years. Twenty-five per- cent of persons with diabetes in the United States
10、do not know they have diabetes. Another 57 million people in the United States have prediabetes (1), defined as people with impaired fasting glucose (IFG) or impaired glucose toler- ance (IGT), some of whom in fact already have the char- acteristic microvascular changes resulting from diabetes itsel
11、f (2,3). Worldwide, the number of people with predia- betes is estimated to be 314 million and is projected to be 418 million in 2025 (4). As the prevalence of and progres- sion to diabetes continue to increase, diabetes-related mor- bidity and mortality have emerged as major public health care issu
12、es. Diabetes is expensivethe associated yearly cost of diabetes in the United States is $174 billion. Direct costs related to diabetes, diabetes complications, and gen- eral medical care are $116 billion, and indirect costs are $58 billion from illness, disability, and premature mortality (5).Predia
13、betes raises short-term absolute risk of type 2 diabetes by 3-to 10-fold, with some populations exhibiting greater risk than others (6,7). People with diabetes are vul- nerable to multiple and complex medical complications. These complications involve both cardiovascular disease (CVD) (heart disease
14、, stroke, and peripheral vascular dis- ease) and microvascular disease (ie, retinopathy, neuropa- thy, and microalbuminuria). Most patients with diabetes die of CVD (8).Epidemiologic evidence suggests that the complica- tions of diabetes begin early in the progression from nor- mal glucose tolerance
15、 to frank diabetes. Early identification and treatment of persons with prediabetes have the poten- tial to reduce or delay the progression to diabetes (9-13) and related CVD (14,15) and microvascular disease (16).Despite the clear origins of diabetes-related compli- cations early in the prediabetic
16、state, few recommenda- tions have been made for the diagnosis and management of patients with prediabetes. No medications are approved by the US Food and Drug Administration for addressing either IFG or IGT. Most insurance companies deny pay-ment for lifestyle treatment to prevent diabetes. There are differences in opinion among health care professionals regarding the therapeutic approach to treating people with prediabetes. Many of these
