The prevalence of type 2 diabetes is increasing in the United States according to Dr. Steven Reisman, Director of the New York Cardiac Diagnostic Center and a cardiologist in New York City. Pre-diabetes is usually defined as an elevation of fasting or post-prandial glucose levels. The American Diabetes Association has defined impaired fasting glucose as a level of 100 to 125 mg/dl. Also, an elevation in hemoglobin A1c or glycosylated hemoglobin (HbA1c) at a level of 5.7% to 6.4% may also represent pre-diabetes.

 

Metabolic Syndrome is related to pre-diabetes. Metabolic Syndrome is defined as any three of the following five components. These components include an elevated glucose level, abdominal obesity, elevated blood pressure, elevated triglycerides, and reduced high-density lipoprotein (HDL) cholesterol. Most individuals with metabolic syndrome have abdominal obesity. It is felt that insulin resistance may be mediating the metabolic risk factors of the metabolic syndrome. Most people with metabolic syndrome have insulin-resistance. It should be noted that the prevalence of pre-diabetes and metabolic syndrome overlap but not exactly. One can consider the metabolic syndrome as a pre-diabetic state. When comparing individuals without metabolic syndrome, those with this syndrome have an approximate 5-fold increase in diabetes risk. Once pre-diabetes is combined with metabolic syndrome, the risk is increased even more for diabetes.

 

The major adverse outcomes in individuals with pre-diabetes are macrovascular disease and type 2 diabetes, the leading contributors to microvascular disease. Macrovascular disease occurs both before and after the onset of diabetes, whereas microvascular disease occurs predominately several years after becoming diabetic. Metabolic Syndrome is a risk factor for macrovascular disease. Initial management is lifestyle intervention including weight reduction in obese subjects, reduced intake of dietary saturated and trans-fatty acids, cholesterol, and sodium along with increased physical activity.

 

According to Dr. Steven Reisman the Director of the New York Cardiac Diagnostic Center and a cardiologist in New York City these initial steps of lifestyle intervention in first line management should be emphasized to this group of individuals along with a thorough assessment of cardiovascular risk.