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Impaired Fasting Glucose

  1. IFG is acceptable as a holding category. Use clinical discretion to determine if further testing is needed.

  2. Since all patients with IFG should have diet, lifestyle, weight, blood pressure, lipid and smoking interventions as required then all reasonable interventions can be made without the knowledge of the diagnosis of diabetes. 

  3. In individuals with IFG, the diagnosis of diabetes and drug interventions for glycaemic control may confer very little benefit in older patients (aged >70 years), or in those with established extensive co-morbidity or those who are near the end of life – indeed they may bring harm (side effects including weight gain and hypoglycaemia).

  4. The very few patients in whom diabetes will be missed or in whom diabetes will develop subsequently will be recaptured in annual retesting.

  5. The patients view should also be considered since the diagnosis of diabetes carries legal and occupational repercussions.

Those diagnosed with Impaired Fasting Glucose/Impaired Glucose Tolerance or history of Gestational Diabetes mellitus should be entered on the risk register and recalled for annual diabetes screening.

Management

People with impaired fasting glucose (IFG),  impaired glucose tolerance (IGT) and history of gestational diabetes (GDM) are at high risk of developing diabetes and should receive active management .There is evidence that the onset of type 2 diabetes can be prevented or delayed in people with pre-diabetes.

  • CVD risk scored with QRISK2

  • Diabetes prevention policies that focus on lifestyle modification, specifically modest weight loss and increased physical activity, are also very likely to have additional health benefits

  • Modest weight loss – 5-10% of bodyweight in people who are overweight

  • Regular physical activity

  • Follow-up counselling

  • Close attention and appropriate treatment for other cardiovascular risk factors (tobacco use, blood pressure, lipids)

  • Perform regular surveillance with a fasting plasma glucose and HbA1c every year-repeat in 1yrs time or sooner if symptomatic