Shobha Rao, MD, Assistant Professor, Department of Family Practice and Community Medicine, UT Southwestern, Dallas, TX, USA.

Impaired glucose tolerance and impaired fasting glucose (prediabetes) form an intermediate stage in the natural history of diabetes. People with prediabetes are at high risk for developing diabetes and thus are a key target group for primary prevention of the disease. A structured program of lifestyle interventions that includes weight loss and regular exercise has demonstrated benefit in delaying or preventing diabetes among people with prediabetes. Lifestyle interventions are most effective. Pharmacotherapy with metformin, acarbose, orlistat, and thiazolidinediones has also shown success in preventing diabetes, although cost effectiveness of these agents in managing prediabetes has not been assessed.

Key words: prediabetes, screening, primary prevention, impaired glucose tolerance, impaired fasting glucose.

Ellie Chuang, MD and Mark E. Molitch, MD, Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.

The worldwide prevalence of diabetes is expected to double to 300 million people by 2025, and nearly 40% of those currently diabetic are older than 65 years. In those who are at high risk for diabetes, including older adults, intervention with diet and exercise has been shown to markedly reduce the development of diabetes. Medications such as metformin, acarbose, troglitazone, pravastatin, ramipril, losartan and estrogen/progestin also have been shown to be effective, although benefits in older patients have not always been demonstrated. Implementation of lifestyle changes in people of all ages could dramatically reduce the size of the developing diabetes epidemic.
Key words: diabetes, primary prevention, impaired glucose tolerance, impaired fasting glucose, older adults.

David C.W. Lau, MD, PhD, FRCPC, Professor of Medicine, Biochemistry and Molecular Biology; Director, Julia McFarlane Diabetes Research Centre, University of Calgary, Calgary, AB.

As the population ages, the diagnosis of Type 2 diabetes is expected to skyrocket over the next two decades. Diabetes is diagnosed by a fasting venous plasma glucose level of equal to or greater than 7mmol/L or, in the presence of classic symptoms of hyperglycemia, a casual plasma glucose value greater than 11.1mmol/L. Early diagnosis, screening and prevention of diabetes in the elderly will greatly reduce the burden of this serious chronic disease that is associated with increased morbidity and mortality.
Key words: impaired glucose tolerance, diagnosis, screening, prevention, Type 2 diabetes

The Diabetes Epidemic
Diabetes is now reaching epidemic proportions in Canada and the U.