How can you control pre-diabetes?
A lifestyle change is the fundamental basis of pre-diabetes management. If you are identified to be of risk, you should reduce your body weight by five to 10 percent. This modest weight loss has been found to decrease body fat, blood pressure, blood glucose, LDL cholesterol and triglyceride levels. A regular moderate intensity physical exercise of 30 to 60 minutes daily is recommended. A dietitian’s help is necessary for dietary guidance for total calorie restriction, increased fiber intake and limitations of carbohydrate intake. Sibutramine and Orlistat are two approved medications for weight loss and may be used when nonpharmacological approach is ineffective. Bariatric surgery is reserved for patients who are morbidly obese [BMI > 40 Kg/ sq.M] or, with significant risk factors. The current consensus guidelines recommend lipid and blood pressure targets in pre-diabetes to be the same as in diabetes. Management principle for hypertension and dyslipidemia in prediabetes is the same for that in diabetes patients.

Drugs to lower blood glucose in pre-diabetes
The American Food and Drug Administration [FDA] has not approved any glucose lowering drug in pre-diabetes. However, strong evidence exists from randomized controlled trials that therapeutic interventions may be beneficial in some patients after careful assessment. Metformin and Acarbose are safe medicines and have shown good results in reducing progression to diabetes. The newer DPP-IV inhibitors hold much promise but further studies will be necessary for their use in prediabetes.

Pre-diabetes monitoring
Individuals with pre-diabetes should have at least an annual screening of fasting and post-glucose blood glucose checks, HbA1c assessment, lipid profile and blood pressure checks. Body weight should be measured too. Recently, annual screening for Microalbuminuria has also been recommended.

(This article is based upon the recommendations of the American Association of Clinical Endocrinologists and American College of Endocrinology – consensus conference held in Washington DC, July 2008.)