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Brian Vastag

JAMA. 2002;287:2494.

Drawing on several large studies, leading US diabetes research and advocacy groups are recommending screening for "prediabetes," a condition marked by glucose levels above normal but below the threshold for type 2 diabetes mellitus. Blood glucose levels in this range often lead within a decade to diabetes and raise the risk for heart attack and stroke.

The recommendations call for physicians to give fasting plasma glucose or oral glucose tolerance tests to overweight people aged 45 years and older. The same tests should be considered for people younger than 45 if they have a body-mass index greater than 25 kg/m² and another risk factor, particularly hypertension or a family history of diabetes. Overweight nonwhites are also considered at high risk.

While individuals with prediabetes glucose levels need counseling about lifestyle changes that can delay or prevent diabetes, drug therapy is generally not warranted and has not been adequately tested in this group, according to the recommendations of the American Diabetes Association and the National Institute of Diabetes and Digestive and Kidney Diseases. Regular follow-up counseling that encourages modest weight loss and light exercise appears to be important for helping patients successfully reduce blood glucose levels (Diabetes Care. 2002;25:742-749).

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