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Diabetes: A Multifaceted Syndrome with Treatment Considerations in Dentistry
Pre-Diabetes: A Silent Epidemic

Course Author(s): Lynne H. Slim, RDH, BSDH, MSDH; Cynthia A. Stegeman, RDH, EdD, RD, LD, CDE, FAND

Pre-Diabetes: A Silent Epidemic

Pre-diabetes, also referred to as impaired fasting glucose (IFG) or impaired glucose tolerance (IGT), is an glucose state located between nondiabetes and diabetes. Table 1 indicates the specific values obtained from plasma glucose testing for diagnosis. A diagnosis of pre-diabetes should not be ignored by the patient since it is strongly associated with an increased risk of diabetes and with the resulting macrovascular and microvascular complications.

Table 1. Recommended Diabetes Values.6

Normoglycemia

  • Fasting Plasma Glucose (FPG)
    Less Than 100 mg/dL
  • Casual Plasma Glucose (Casual PG)
    Less Than 140 mg/dL
  • Less Than 5.7% A1C

 

Pre-Diabetes

  • Impaired Fasting Glucose (IFG)
    FPG = 100-125 mg/dL
  • Impaired Glucose Tolerance (IGT)
    2-hour plasma glucose = 140-199 mg/dL
  • 5.7-6.4% A1C

 

Diabetes Diagnosis - confirmed on a subsequent day

  • FPG ≥ 126 mg/dL Casual mg/dL
  • Random or 2-hour plasma glucose ≥ 200 mg/dL
  • A1C ≥ 6.5%

 

Target Range

  • Pre-prandial Plasma Glucose
    80-130 mg/dL
  • Post-prandial Plasma Glucose (1-2 hours after a meal)
    Less Than 180 mg/dL
  • A1C
    • Less Than 7% for nonpregnant adults
    • Less Than 7.5% for all pediatric age groups

 

Hypoglycemia

Level 1 – Alert Value

  • Less Than 70 mg/dL

Level 2 – Clinically Significant

  • Less Than 54 mg/dL

Level 3 – Severe

  • No Specific Threshold
  • Cognitive impairment
  • Requires assistance from another person for recovery

 

Diabetic Ketoacidosis (DKA)

  • Typically T1D
    Greater Than 250 mg/dL

 

Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS)

  • Typically T2D
    Greater Than 600 mg/dL

 

Blood Pressure

  • Goal: Less Than 130/90 mmHg

 

A1C

  • Acceptable is less than 7%

 

Uncontrolled

  • 200 mg/dL on 3 consecutive readings

There are categories of increased risk for diabetes and pre-diabetes and the following recommendations have been suggested:

  1. Testing to determine risk for future diabetes in asymptomatic individuals who are overweight or obese (BMI Less Than 25 kg/m2 or Less Than 23 kg/m2 in Asian Americans) and those who have one or more additional risk factors for diabetes. For all patients, especially those who are overweight or obese, testing should begin at age 45.
  2. If test results are normal, re-test at a minimum of 3-year intervals.
  3. For patients with pre-diabetes, treat cardiovascular disease (CVD) risk factors if appropriate.

In children and adolescents who are overweight or obese and who have additional risk factors for diabetes, testing for pre-diabetes is recommended.6

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