While the American Association of Clinical Endocrinologists (AACE) guidelines for diabetes prevention offer an HbA1c goal of normoglycemia when a patient is in the range of prediabetes, AACE presented a call for additional guidelines in lipids and blood pressure when treating patients with prediabetes.
Leigh Perreault, MD, associate professor of medicine at the University of Colorado Anschutz Medical Campus, stated during her presentation at the AACE 23rd Annual Scientific & Clinical Congress that, currently, "there are no guidelines anywhere for exactly what our goals should be for lipids or for blood pressure for these people." "We should come together as a community to create these guidelines because there are so many people out there who could probably benefit."
Perreault presented extensive data supporting the AACE guidelines that instruct physicians to aim for normoglycemia in patients with prediabetes. The Diabetes Prevention Program, she explained, showed that when patients in the range of prediabetes returned to normoglycemia at any given point over the 10 years of observation, their risk of transitioning to diabetes was reduced. If they returned to normoglycemia more than once, they further reduced their risk.
"If we set that goal as normal glucose regulation, we can reduce their risk tremendously, up to 70% for people in whom we can actually get them there and keep them there," Perreault said."The good news from this analysis is it didn't matter how people got to normal, as long as people got to normal. This is a change, a shift in our paradigm, a rethinking of diabetes care or diabetes prevention."
This shift should also encompass reducing the cardiovascular risk of these patients with prediabetes, she said.
"There are data showing we can reduce cardiovascular risk factors and cardiovascular risk in people with prediabetes by treating them," Perreault said. "People can get complications of diabetes even if they never develop diabetes. People with prediabetes can get these complications. And the prevention of diabetes, particularly if [normoglycemia] can be achieved, is key and the risk reduction of cardiovascular disease might be right behind it."
Therefore, there is need to consider the lipid profile and blood pressure levels and create guidelines for the best management of patients with prediabetes.
Perreault L. W22. Presented at: AACE 23rd Annual Scientific & Clinical Congress; May 13-18, 2014; Las Vegas, Nevada.