Approaches to Treatment of Pre-Diabetes and Obesity and Promising New Approaches to Type 2 Diabetes

Abstract

Perspectives on the News commentaries are part of a free monthly CME activity. The Mount Sinai School of Medicine, New York, New York, designates this activity for 2.0 AMA PRA Category 1 credits. If you wish to participate, review this article and visit www.diabetes.procampus.net to complete a posttest and receive a certificate. The Mount Sinai School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians . This article is based on presentations at the Tulane University Diabetes Update on 8 December 2007 in New Orleans, Louisiana; at the Mount Sinai Medical Center Diabetes Grand Rounds in New York, New York, on 6 December 2007; and at the American Diabetes Association's 55th Annual Advanced Postgraduate Course held 1–3 February 2008 in San Francisco, California. These lectures, addressing differing views of various speakers on various aspects of diabetes prevention, obesity, and new treatments for type 2 diabetes, are available online at http://professional.diabetes.org. Richard Bergenstal (Minneapolis, MN) reviewed approaches to treatment of pre-diabetes at the American Diabetes Association Postgraduate Course. The number of individuals with diabetes worldwide is projected to increase to 333 million by 2025, and the annual cost of diabetes in the U.S. today has reached $174 billion (1). The burden of complications among diabetic individuals aged >65 years in the U.S. includes doubling of the rates of myocardial infarction and congestive heart failure (2). Bergenstal reviewed current guidelines for using elevated fasting and 2-h glucose, as well as the growing use of A1C, in the assessment of the pre-diabetic state. The presence of both impaired fasting glucose (IFG) (≥100 mg/dl) and impaired glucose tolerance (IGT) (blood glucose 2 h after 75-g oral glucose ≥140 mg/dl) doubles the risk of progression to diabetes. Insulin secretory defects are seen in …