To be or not to be: Early diagnosis of Diabetes

One of my patients, who is clearly overweight, has h/o hypertension, hyperlipidaemia and previous diagnosis and treatment of IHD, just had her OGTT. Her baseline (fasting) glucose is 6.0 mmol/l and 2 hours postprandial value of 11.3 mmol/l. Without hesitation I have declared her new Diabetic, and, with her high TG and waist circumference (and HPT) enough to earn her Metabolic syndrome.

Though WHO requires one to be symptomatic with one ‘diagnostic’ reading, I think the above is a diagnosis of ‘convenience’ since the evidence is overwhelming that early treatment (esp with Metformin) will be beneficial.

For no expert in Endocrine like me, basic definitions are useful. Anything between 6 to 7 mmol fasting is called Impaired Fasting Glucose, while a value between 7.8 and 11.0 mmol 2hr post prandial is called Impaired Glucose Tolerance. Experts feel that there are differences in term of risks between the two groups. Err..me being a Cardiologist, any Endocrinologist over there can clarify this…