Identification of High-Risk Subgroups for Type 2 Diabetes in Individuals with Normal Fasting Glucose

Subgroup Stratification

• Women with a history of gestational diabetes have a substantially elevated risk, with 4% developing diabetes at 9 months postpartum and 19% at 9 years, according to the European Association for the Study of Diabetes 1
• This group requires screening at least every 1-3 years for life, as recommended by the American Diabetes Association 2
• Individuals with HbA1c ≥5.7% have a risk of diabetes similar to that of high-risk participants in the Diabetes Prevention Program, with the American Diabetes Association recommending aggressive interventions and close monitoring for those with HbA1c >6.0% 2
• The American Diabetes Association suggests that this subgroup should be screened annually 2, 3
• Obesity, particularly with abdominal/visceral distribution, promotes insulin resistance contributing to the development of glucose abnormalities, with the European Association for the Study of Obesity recommending consideration of this factor in risk stratification 4
• Asian-Americans have an increased risk with BMI ≥23 kg/m², approximately 15 pounds less than other ethnic groups, according to the American Heart Association 5
• Overweight (BMI ≥25 kg/m²) is an established risk factor that should be combined with other factors for stratification, as recommended by the National Institute of Diabetes and Digestive and Kidney Diseases 6, 7
• Having parents or siblings with diabetes is a significant independent risk factor, with the American Diabetes Association recommending consideration of this factor, especially in combination with other metabolic factors 6, 2, 3
• The American Diabetes Association recommends that individuals with a history of gestational diabetes, HbA1c 5.7-6.4%, or other high-risk factors should be prioritized for annual screening 2
• The American Heart Association recommends that individuals with obesity, history of gestational diabetes, or other high-risk factors should be prioritized for screening every 1-3 years 5, 2, 3

Risk Stratification Algorithm

• For individuals with normal fasting glucose (<100 mg/dL), prioritize screening in this order:

Clinical Considerations

• The American Diabetes Association recommends that interventions such as lifestyle changes (5-7% weight loss and 150 minutes/week of moderate activity) can reduce the risk of progression to diabetes by 58% in people with impaired glucose tolerance 8