Managed Care - December 2008 - (Page 34)

ACE and AACE recommend treatment plan for prediabetes medications on a patient-by patient basis, but only if the patient is obese or there are other risk factors, such as heart disease. Benefits delayed “That is a big part of the problem,” says Ralph DeFronzo, MD, professor of medicine and chief of the diabetes division at the University of Texas Health Science • Fasting plasma glucose, hemoglobin A1c and lipids should be checked every six months Center in San Antonio. He says the current • Intensive lifestyle management should be started, including standard of care has delayed the use of reducing weight by 5 percent to 10 percent and beginning medications that may provide long-term a program of regular, moderately intense physical activity health benefits, such as sustained insulin of 30 to 60 minutes at least five days a week sensitivity and beta cell function. • Drug treatment may be considered for those at particularly The clinical definition of prediabetes, high risk. Metformin and acarbose were recommended as according to the ADA, is impaired fasting both inexpensive and safe glucose (plasma glucose level of 100 to • Lipid targets are the same as for diabetic patients (LDL lev<126 mg/dL after an overnight fast), imels of 100 mg/dL), and statins are recommended paired glucose tolerance (plasma glucose • Blood pressure targets also are the same as for diabetic paof 140 to <200 mg/dL after two hours of tients (systolic blood pressure less than 130 mm Hg and dian oral glucose tolerance test), or both. astolic of 80 mm Hg), and ACE inhibitors and angiotensin receptor blockers are considered first-line agents Higher glucose levels, especially from an impaired glucose tolerance test, results Source: “Consensus Statement on the Diagnosis and Management of Pre-Diabetes in in a diagnosis of diabetes. Medicare and the Continuum of Hyperglycemia,” American College of Endocrinology and American Association of Clinical Endocrinologists, July 23, 2008 health plans have an ICD-9 code for prediabetes (790.29). However, a diagnosis of prediabetes is not the same as a diagnosis of diapercent of body weight and on increasing physical betes, and some health plans will not pay for nuactivity to at least 150 minutes of moderate activtritional counseling or medication under that code. ity, such as walking, every week. DeFronzo believes that by the time a person is acThe Diabetes Prevention Program reported that tually diagnosed with diabetes, 80 percent of although 42 percent of adults with prediabetes beta cell function has been lost. So patients tried to lose or control weight, reduce fat or should turn to medications earlier than most calories, and increase physical activity, one guidelines recommend, especially metformin fourth did not engage in any of these riskand thiazolidinediones (TZD) to sensitize reduction activities. the body to insulin and exenatide (Byetta) to A CDC analysis of NHIS data among the 4 help increase insulin secretion by the beta percent reporting a diagnosis of prediabetes cells and potentially stimulate the cells’ abilfound similar results. Among patients told they have prediabetes, 68 percent had tried to lose Studies show that ity to replicate. Prediabetes is a term that came into genor control weight, 55 percent had increased “the earlier treateral use about seven years ago, after publicaphysical activity or exercise, 60 percent had re- ment starts, the tion of results from the federal Diabetes Preduced dietary fat or calories, and 42 percent longer benefits last,” says James vention Program (DPP) intervention trial. had engaged in all three activities. Most reDudl, MD, the Endocrinologists in the DPP trial sanctioned ported failing to meet their goals, however. diabetes leader use of the single term rather “borderline diRegardless of lifestyle intervention failures, at Kaiser Permahowever, most health plans require a diagnosis nente’s Care Man- abetes” or “high blood sugar.” Screening for prediabetes — let alone of diabetes to pay for the medications that an agement Institute. treatment — remains dangerously underutiincreasing number of endocrinologists think lized, says Sue Kirkman, MD, ADA vice president should be available to people with prediabetes. for clinical affairs. “We know the risk factors for preSome plans will pay for prediabetes-designated A panel convened by the American College of Endocrinology and the American Association of Clinical Endocrinologists developed recommendations for treating prediabetes. Among them: 34 MANAGED CARE / DECEMBER 2008

Table of Contents Feed for the Digital Edition of Managed Care - December 2008

Managed Care - December 2008 Editor's Memo Contents Legislation & Regulation News and Commentary Medication Management Compensation Monitor ICD-10 Offers Huge Opportunity, Challenge Part D at a Crossroads Plans Can Weather the Financial Crisis DM vs. Medical Home? Tackle Prediabetes Reasonable Approach to Morning Sickness Formulary Files Tomorrow's Medicine Outlook

Managed Care - December 2008

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.