Management of prediabetes 
Table 1: Diabetes terminology
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Prediabetes is the term recommended for patients with impaired glucose tolerance or impaired fasting glucose (Table 1).2 Evaluation of patients with elevated glucose levels involves an appropriate history, physical examination, and laboratory
evaluation. If a diagnosis of prediabetes is made, patients should be referred for education and lifestyle interventions.
Primary care physicians should monitor patient progress and review treatment goals on an annual basis. Treatment entails intensive
lifestyle behavioral changes that include a nutrition and physical activity plan by a registered dietitian, health educator,
or other qualified health professional. Ongoing support should be provided for the behavioral changes to be successful. In
addition, patients should undergo appropriate cardiovascular risk reduction.
Recent randomized clinical trials have demonstrated efficacy in preventing diabetes by pharmacotherapy with biguanides, glitazones,
and alpha-glucosidase inhibitors. However, lifestyle changes are most efficacious. In a Diabetes Prevention Program Research
Group study, efficacy of lifestyle modification was most pronounced in participants more than 60 years of age.4 Moderate activity of 150 minutes per week reduced the development of diabetes by 71% in this age group. Patients who meet treatment goals should continue to be evaluated yearly. Patients who fail to meet treatment goals should
undergo further intensive education and counseling on lifestyle interventions. Management of diabetes The major goal for the management of diabetes is to provide a comprehensive approach that focuses on self-management strategies
such as proper nutrition, increased physical activity (150 minutes per week), and pharmacologic therapy to prevent diabetes-associated
complications. In managing the patient with diabetes, it is important to obtain a detailed history of past and current treatment
programs, including nutrition, physical activity, and medications. Additionally, records of recent glucose monitoring should
be reviewed, and the frequency of complications such as hypoglycemia and severe hyperglycemia should be obtained. Medical nutrition The goal of medical nutrition therapy is to assist patients in making lifestyle and behavioral changes that will improve
metabolic outcomes. The ICSI recommendations are based on promoting optimal nutrition through healthy food choices and active
lifestyle to maintain normal blood glucose, blood pressure, and lipid levels. Achieving these goals can help to reduce the
risk for chronic complications of diabetes and macrovascular and microvascular diseases. Instruction on medical nutrition
may be offered by a provider with medical expertise in this topic and is covered by Medicare Part B. Aging is associated with many changes that may predispose older adults to nutritional deficiencies. Such changes include alterations
in taste, smell, mastication, and hepatic and renal function. In addition, common problems such as difficulty in preparing
food and polypharmacy can interfere with adequate nutrition. Because of these concerns, nutrition prescription should be individualized
and must start with a thorough assessment of clinical, nutritional, psychosocial, and environmental factors. Limited research
exists on the changes in nutritional needs with aging; therefore, the recommendations for older patients must be extrapolated
from the general population. Weight control Moderate weight loss of 5% can improve metabolic goals in overweight or obese patients.5 Combining lower fat and caloric consumption with 30 minutes of regular physical activity most days provides the greatest
benefit. The effectiveness of pharmacologic interventions for weight loss has not been convincingly demonstrated.
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