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‘Prediabetes’ affects approximately 20% of New Zealand adults and is defined as either:
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HbA1c 41 – 49 mmol/mol (single measurement satisfactory if no intercurrent illness)
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Fasting glucose 6.1 – 6.9 mmol/L (previously known as impaired fasting glucose)
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2 hour glucose on 75 g glucose tolerance test 7.8 – 11 mmol/L (previously known as impaired glucose tolerance)
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An HbA1c may be unreliable in:
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Any haemoglobinopathy e.g. sickle cell anaemia, thalassemia
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Altered red cell turnover e.g. bleeding, haemolysis, significant iron deficiency etc.
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Post blood transfusion
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Second and third trimesters of pregnancy
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The term ‘prediabetes’ is a misnomer because patients with prediabetes are still at an increased risk of macrovascular complications and early death.
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Treatment of prediabetes should be discussed to prevent or delay the progression to type 2 diabetes and improve survival. The treatment options that should be considered are:
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Pharmacological management e.g. liraglutide, duromine, orlistat, naltrexone/bupropion
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Bariatric surgery