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Case Study: Screening and Treatment of Pre-Diabetes in Primary Care

The first 300 words of the full text of this article appear below.

	Presentation

 
J.M., a 48-year-old Hispanic man, was seen in the primary care clinic for routine follow-up of hypertension, for which he had been treated for the past 8 years. His only medication was lisinopril, 20 mg/day. Home blood pressure monitoring averaged 128/82 mmHg. He had a family history for hypertension, type 2 diabetes, and coronary artery disease. J.M. reported a 20-lb weight gain over the past year, along with a sedentary lifestyle with no regular exercise routine. Other medical history was negative, including symptoms of fatigue, polyuria, or polydipsia. He denied past or current tobacco use.

J.M. presented with a waist size of 42 inches, BMI of 34 kg/m², and blood pressure of 125/80 mmHg. A subsequent lipoprotein profile demonstrated the common pattern associated with pre-diabetes, including a low HDL cholesterol (30 mg/dl) and a high triglyceride level (185 mg/dl). The LDL was mildly elevated (132 mg/dl), and total cholesterol was 199 mg/dl. His fasting glucose was 111 mg/dl, with a repeat value of 115 mg/dl one week later.

	Questions

 

1. Does this patient have pre-diabetes?
   
2. When should patients be screened for pre-diabetes?
   
3. How should pre-diabetes be treated in primary care settings?
   

	Commentary

 
Type 2 diabetes is a significant cause of death, disability, and health care burden in the United States, affecting an estimated 16 million Americans. A prodromal phase of this disease, in which patients manifest impaired glucose metabolism, has recently been identified as "pre-diabetes" by the U.S. Secretary of Health and Human Services.1 Pre-diabetes is also a major health care burden estimated to affect at least an additional 16 million Americans,2 and possibly as many as 43 million with the new criteria for impaired fasting glucose (IFG) being reduced to 100 mg/dl.3 Pre-diabetes is highly associated with concomitant cardiovascular risk factors and has been found to confer an . . . [Full Text of this Article]

	Clinical Pearls

 

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