Diabetes Management and Prediabetes Quiz

Study Notes

Prediabetes/Intermediate Hyperglycemia: Diagnosed using one of these criteria:
- Impaired fasting glucose (IFG): Fasting plasma glucose (FPG) 110-125 mg/dL
- Impaired glucose tolerance (IGT): 2-hour plasma glucose (2-h PG) 140-199 mg/dL during 75-g oral glucose tolerance test (OGTT)
- HbA1c 5.7%-6.4%
Diabetes: Diagnosed using one of these criteria:
- FPG ≥126 mg/dL
- FPG ≥126 mg/dL and/or 2-h PG ≥200 mg/dL using 75-g OGTT
- Random plasma glucose ≥200 mg/dL with classic diabetes symptoms
- HbA1c ≥6.5%
Limited Care: Diagnostic criteria same as for Diabetes. Asymptomatic individuals with a single abnormal test should repeat the test to confirm the diagnosis unless the result is clearly abnormal. Individuals with a diagnosis of diabetes should be classified using the WHO system.

Lifestyle Modification:
- Weight loss (10% of current body weight)
- Adequate sleep (6-8 hours daily)
- Daily exercise (minimum 1 hour)
Metformin: Initiate 500mg once daily if HbA1c still high after 6 months of lifestyle modification

Initial Treatment:
- Start Metformin 500mg twice daily (maximum 2.5g/day), with meals.
- Gradually increase metformin dose weekly up to 2.5 grams in divided doses.
HbA1c Target:
- Young patients: 6-7%
- Older patients: 7-8%
Dual Therapy: If HbA1c is 1.5 points above target, initiate dual therapy, along with one of these medications:
- Glimepride
- Sitagliptin
- Voglibose
- Pioglitazone
- Dapagliflozin (Indian setting)

High Glycemic Parameters or Persistent High HbA1c Levels: Consider initiating insulin.
Basal Insulin: Initiation at bedtime to suppress hepatic glucose production (starting dose of 0.1-0.2 IU/kg/day or 10 units as a whole).
Short-Acting Insulin: Initiate short-acting insulin (regular insulin, lispro, or aspart) before the main meal (lunch) at a dose of 4 units or 0.1 IU/kg body weight.