A Consensus of Key Opinion Leaders on the Management of Pre-diabetes in the Asia-Pacific Region
Keywords:impaired glucose tolerance, pre-diabetes, Asia
The Asia-Pacific region carries a high disease burden, with over half of the global diabetic population residing in this region. Increasing evidence shows that without targeted intervention, the progression from impaired glucose tolerance (IGT) to type 2 diabetes occurs more frequently in Asians compared with Caucasians. Furthermore, IGT is independently associated with an increased risk of cardiovascular disease, and should be managed as early as possible. Because diabetes is now a major public health issue, strategies aimed at prevention and treatment are urgently required. Lifestyle modification, including weight loss, dietary changes and increased physical activity, play a major role in controlling the disease. Significant evidence also supports the effectiveness of a combination of lifestyle modification and pharmacologic therapy, such as metformin, in delaying the onset of diabetes. Although the importance of lifestyle interventions is well recognized throughout Asia, many countries do not have formal recommendations to guide the diagnosis and management of individuals at risk of progression to diabetes. At a recent regional meeting, experts from the Asian region convened to develop consensus recommendations to guide clinicians in the management of Asian patients with pre-diabetes. These consensus recommendations provide a clear and concise approach to the management of individuals with IGT based on the available evidence and current best clinical practice.
International Diabetes Federation. Diabetes Atlas 6th edition poster update, 2014. http://www.idf.org/sites/default/files/Atlas-poster-2014_EN.pdf. Accessed September 22, 2016.
Ramachandran A, Snehalatha C, Ma RC. Diabetes in South-East Asia: an update. Diabetes Res Clin Pract. 2014;103(2):231-7. PMID : 24300015. https://doi.org/10.1016/j.diabres.2013.11.011.
Wan Nazaimoon WM, Md Isa SH, Wan Mohamad WB, et al. Prevalence of diabetes in Malaysia and usefulness of HbA1c as a diagnostic criterion. Diabet Med. 2013;30(7):825-8. PMID: 23413941. https://doi.org/10.1111/dme.12161.
Geiss LS, James C, Gregg EW, Albright A, Williamson DF, Cowie CC. Diabetes risk reduction behaviors among U.S. adults with prediabetes. Am J Prev Med. 2010;38(4):403-9. PMID: 20307809. https://doi.org/10.1016/j.amepre.2009.12.0.
Mustafa N, Kamarudin NA, Ismail AA, et al. Prevalence of abnormal glucose tolerance and risk factors in urban and rural Malaysia. Diabetes Care 2011;34(6):1362-4. PMID: 21498788 PMCID: PMC3114358. https://doi.org/10.2337/dc11-0005.
Garber AJ, Abrahamson MJ, Barzilay JI, et al. Consensus statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the comprehensive type 2 diabetes management algorithm—2016 Executive Summary. Endocr Pract. 2016;22(1):84-113. PMID : 26731084. https://doi.org/10.4158/EP151126.CS.
Mata-Cases M, Artola S, Escalada J, et al. Consensus on the detection and management of prediabetes. Consensus and Clinical Guidelines Working Group of the Spanish Diabetes Society. Rev Clin Esp. 2015;215(2):117-29. PMID : 25553948. https://doi.org/10.1016/j.rce.2014.10.012.
Yan ST, Xiao HY, Tian H, et al. The cutoffs and performance of glycated hemoglobin for diagnosing diabetes and prediabetes in a young and middle-aged population and in an elderly population. Diabetes Res Clin Pract. 2015;109(2):238-45. PMID: 26059072. https://doi.org/10.1016/j.diabres.2015.05.047.
Akter S, Rahman MM, Abe SK, Sultana P. Prevalence of diabetes and prediabetes and their risk factors among Bangladeshi adults: a nationwide survey. Bull World Health Organ. 2014;92(3):204-13,213A. PMID: 24700980. PMCID: PMC3949596. https://doi.org/10.2471/BLT.13.128371.
Mayega RW, Guwatudde D, Makumbi F, et al. Diabetes and pre-diabetes among persons aged 35 to 60 years in eastern Uganda: Prevalence and associated factors. PLoS One. 2013;8(8):e72554. https://doi.org/10.1371/journal.pone.0072554.
Zhuo X, Zhang P, Selvin E, et al. Alternative HbA1c cutoffs to identify high-risk adults for diabetes prevention: a cost-effectiveness perspective. Am J Prev Med. 2012;42(4):374-81.PMID:22424250. https://doi.org/10.1016/j.amepre.2012.01.003.
American Diabetes Association. Standards of Medical Care in Diabetes—2015. Diabetes Care. 2015;38(Suppl 1):S1-89.
International Diabetes Federation Clinical Guidelines Task Force. Global Guideline for Type 2 Diabetes. Brussels, Belgium: International Diabetes Federation, 2012. http://www.idf.org/e-library/guidelines/79-global-guideline-for-type-2-diabetes.html. Accessed September 22, 2016.
Ministry of Health Malaysia. Clinical practice guidelines—Management of type 2 diabetes mellitus, 5th ed. Putrajaya, Malaysia: Ministry of Health Malaysia, 2015. http://www.acadmed.org.my/index.cfm&menuid=67#Endocrine_Disease.
Ministry of Health Singapore. Diabetes Mellitus—MOH Clinical Practice Guidelines 1/2014. Singapore: Ministry of Health, Singapore, 2014. https://www.moh.gov.sg/content/dam/moh_web/HPP/Doctors/cpg_medical/current/2014/diabetes_mellitus/cpg_Diabetes%20Mellitus%20Summary%20Card%20-%20Jul%202014.pdf.
Task Force on Conceptual Model and Preventive Protocols, Working Group on Primary Care, Food and Health Bureau. Hong Kong Reference Framework for Diabetes Care for Adults in Primary Care Settings, 2013.
Buku Panduan - Pengurus Besar Persatuan Diabetes Indonesia (PB Persadia). 2009.
Bansal N. Prediabetes diagnosis and treatment: A review. World J Diabetes 2015;6(2):6-303. PMCID: PMC4360422. https://doi.org/10.4239/wjd.v6.i2.6.
World Health Organization International Diabetes Federation. Definition and diagnosis of diabetes mellitus and intermediate hyperglycemia: report of a WHO/IDF consultation. Geneva, Switzerland: World Health Organization, 2006. http://www.who.int/diabetes/publications/Definition%20and%20diagnosis%20of%20diabetes_new.pdf.
Pan XR, Li GW, Hu YH et al. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care. 1997;20(4):537-44. PMID: 9096977.
Ramachandran A, Snehalatha C, Mary S et al. The Indian Diabetes Prevention Programme shows that lifestyle modification and metformin prevent type 2 diabetes in Asian Indian subjects with impaired glucose tolerance (IDPP-1). Diabetologia 2006;49(2):289-97. PMID: 16391903. https://doi.org/10.1007/s00125-005-0097-z.
Tuomilehto J, Lindström J, Eriksson JG, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001;344(18):1343-50. https://doi.org/10.1056/NEJM200105033441801.
Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393-403. https://doi.org/10.1056/NEJMoa012512.
International Diabetes Federation. IDF Diabetes Atlas, 6th edition. Brussels, Belgium: International Diabetes Federation, 2013. http://www.idf.org/e-library/epidemiology-research/diabetes-atlas/19-atlas-6th-edition.html. Accessed September 22, 2016.
Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract. 2010;87(1):4-14. PMID: 19896746. https://doi.org/10.1016/j.diabres.2009.10.007.
Soria MLB, Sy RG, Vega BS et al. The incidence of type 2 diabetes mellitus in the Philippines: A 9-year cohort study. Diabetes Res Clin Pract. 2009;86(2):130-3. PMID: 19766344. https://doi.org/10.1016/j.diabres.2009.07.014.
Jayawardena R, Ranasinghe P, Byrne NM, Soares MJ, Katulanda P, Hills AP. Prevalence and trends of the diabetes epidemic in South Asia: A systematic review and meta-analysis. BMC Public Health. 2012;12:380. PMID: 22630043. PMCID: PMC3447674. https://doi.org/10.1186/1471-2458-12-380.
Lindstrӧm J, Ilanne-Parikka P, Peltonen M et al. Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: Follow-up of the Finnish Diabetes Prevention Study. Lancet. 2006;368(9548):1673-9. PMID: 17098085. https://doi.org/10.1016/S0140-6736(06)69701-8.
Diabetes Prevention Program Research Group. Effects of withdrawal from metformin on the development of diabetes in the diabetes prevention program. Diabetes Care. 2003;26(4):977-80. PMID: 12663559. PMCID: PMC1360737.
Moin T, Li J, Duru OK, et al. Metformin prescription for insured adults with prediabetes from 2010 to 2012: A retrospective cohort study. Ann Intern Med. 2015;162(8):542-8. PMID: 25894024. PMCID: PMC4682357. https://doi.org/10.7326/M14-1773.
Chiasson JL, Josse RG, Gomis R, et al. Acarbose for prevention of type 2 diabetes mellitus: the STOP-NIDDM randomised trial. Lancet. 2002;359(9323):2072-7. PMID: 12086760. https://doi.org/ 10.1016/S0140-6736(02)08905-5.
Li G, Zhang P, Wang J, et al. The long-term effect of lifestyle interventions to prevent diabetes in the China Da Qing Diabetes Prevention Study: A 20-year follow-up study. Lancet. 2008;371(9626):1783-9. PMID: 18502303. https://doi.org/10.1016/S0140-6736(08)60766-7.
Li G, Zhang P, Wang J, et al. Cardiovascular mortality, all-cause mortality, and diabetes incidence after lifestyle intervention for people with impaired glucose tolerance in the Da Qing Diabetes Prevention Study: A 23-year follow-up study. Lancet Diabetes Endocrinol 2014;2(6):474-80. PMID: 24731674. https://doi.org/10.1016/S2213-8587(14)70057-9.
Diabetes Prevention Program Research Group. 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet. 2009;374(9702):1677-86. PMID: 19878986. https://doi.org/10.1016/S0140-6736(09)61457-4.
Png ME, Yoong SYY. Evaluating the cost-effectiveness of lifestyle modification versus metformin therapy for the prevention of diabetes in Singapore. PLoS One. 2014;9(9):e107225. https://doi.org/10.1371/journal.pone.0107225.
Alberti KG, Zimmet P, Shaw J. International Diabetes Federation: A consensus on type 2 diabetes prevention. Diabet Med. 2007;24(5):451-63. PMID: 17470191. https://doi.org/ 10.1111/j.1464-5491.2007.02157.x.
World Health Organization. “Diabetes Fact Sheet No. 312.” Reviewed November 2016. http://www.who.int/mediacentre/factsheets/fs312/en/.
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