Table 7.

Iraqi consensus recommendations on prediabetes.

Diagnosis criteria	• FPG = 100-125 mg/dL (5.5-6.93 mmol/L) or, • OGTT = 140-199 mg/dL (7.7-11 mmol/L) or, • HbA1c = 5.7%-6.4% (39 mmol/mol-46 mmol/mol)
Screening	• Patients aged ⩾ 45 years who visit clinic or a hospital in Iraq should be systematically screened for prediabetes using the FINDRISC as precursor to laboratory measurement (FPG for confirmation). • Patients with risk factors for prediabetes23 should be screened opportunistically at a younger age; the risk factors are as follow: • “HbA1c ⩾ 5.7% (39 mmol/mol), IGT, or IFG on previous testing” • “First-degree relative with diabetes” • Women who were diagnosed with Gestational Diabetes Mellitus • “CVD history” • “Hypertension (⩾140/90 mmHg or on therapy for hypertension)” • “HDL cholesterol level < 35 mg/dL (0.90 mmol/L) and/or a triglyceride level > 250 mg/dL (2.82 mmol/L)” • “Women with polycystic ovary syndrome” • “Physical inactivity” • “Other clinical conditions associated with insulin resistance (eg, severe obesity, acanthosis nigricans)” • Metabolic syndrome, nonalcoholic fatty liver disease (NAFLD), Obstructive sleep apnea (OSA), macrosomia, chronic glucocorticoid exposure, atypical antipsychotic therapy use
Management	• Baseline creatinine with estimated glomerular filtration rate (eGFR) and HbA1c value should be obtained. • Management of prediabetes should begin with lifestyle modifications. • Lifestyle change programs should encourage 150 minutes of physical activity per week and loss of 7% body weight. • After 3 months, if lifestyle therapy fails to normalize HbA1c or if HbA1c value approaches 6.5%, metformin immediate release should be added and gradually increased as necessary to 1000 mg twice daily. • Metformin can be added in patients with IFG and/or IGT who also have additional risk factors. • Metformin extended release (XR) is recommended to improve patient compliance or in patients who develop side effects on the immediate release formulation.
Monitoring	• Patients with risk factors for prediabetes and normal laboratory measurements should be re-tested after 3 years. • Patients diagnosed with prediabetes should be tested yearly. • Renal function and vitamin B12 status of patients treated with metformin should be monitored yearly56 • In Iraq, laboratory tests to assess B12 status are not standardized. • Particular attention should be given to patients who are vegetarian and those who present with peripheral neuropathy. • Regarding treatment goals of outpatient non-pregnant T2DM, glucose targets should be individualized and take into account life expectancy, disease duration, presence or absence of micro- and macrovascular complications, CVD risk factors, comorbid conditions, and risk for hypoglycemia, as well as the patient’s psychological status.

Abbreviations: CVD, cardiovascular disease; eGFR, estimated glomerular filtration rate; FINDRISC, Finnish Diabetes Risk Score; FPG, fasting plasma glucose; HDL, high-density lipoprotein; IFG, impaired fasting glucose; IGT, impaired glucose tolerance; NAFLD, nonalcoholic fatty liver disease; OGTT, oral glucose tolerance test; OSA, obstructive sleep apnea; T2DM, type 2 diabetes mellitus; XR, extended release.