Pathology
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Developments in laboratory technology have enabled us to diagnose a variety of diseases at variable times before they become clinically evident or identifiable by routine bedside or laboratory testing.

One such entity is pre-diabetes (or impaired glucose tolerance) which has recently become well described and for which the diagnosis depends upon:

  • An astute clinical suspicion of its presence (of utmost importance) and
  • Measurement of blood glucose levels by an appropriate laboratory technique which defines a normal blood glucose as

a blood glucose of ˃7.0 as highly suggestive of diabetes mellitus and

a blood glucose of 5.6 – 6.9 as prediabetes

  • oral GTT at 2 hours between 7.8 and 11.0 mmol/L as prediabetes
  • Or measurement of HbA1c with values between 6 and 6.5 indicating prediabetes

The uttermost importance of diagnosing pre-diabetes depends upon the basic fact that even though the condition may be largely symptomless it is associated with ongoing pathological changes within the body of which three pathologies are particularly important viz.

  • Cardiovascular damage
  • Kidney damage
  • Progression to type 2 diabetes in 10 years or less

Prediabetes is not infrequently associated with silent kidney disease:

In addition to the use of blood glucose and/or HbA1c to diagnose prediabetes, the determination of microalbuminuria is essential in detecting glomerular damage as early as possible.

There are a number of risk factors that tend to aid in the diagnosis of prediabetes. These are:

  • Being overweight
  • Inactivity
  • Advancing age (generally over 45 years)
  • Family history of type 2 diabetes
  • Previous gestational diabetes
  • Polycystic ovary syndrome
  • Sleep disturbances (regularly sleeping

In any patient with prediabetes it is particularly important to check their lipid profile and their microalbuminuria at least yearly.

Treatment of prediabetes is largely directed at life style changes but sometimes medications such as metformin and acarbose may be required if the prediabetes cannot be adequately controlled or the patient is at high risk for complications.

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