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Impaired Glucose Tolerance and Coronary Artery Disease 127
and Peripheral Artery Disease

approach through multidisciplinary team is needed. for secondary cardiovascular prevention, and for pa-
Good community diabetic care and early recognition tients at high risk of first event, could insulin prevent
of symptomatic patients should be done. diabetes? In IFG and IGT, reducing beta cell works by
life style, TZD Metformin Acarbose reduce diabetes.
Many therapeutic approaches delay or prevent the Insulin does not have a major role in patients who do
progression to diabetes; mellitus and are appropriate not have overt diabetes, unless nonpharmacological
for the patient with or without established coronary forms or drugs are contraindicated
artery disease.
References :
Nonpharmocological
1. Glucose tolerance and cardiovascular mortality: comparison of fasting and
Modalities in IGT in CAD and DVD: 2-hour diagnostic criteria. Arch Intern Med.2001;161:397-405.PubMed
Physical Activity: 2. Haffner SM,Stern MP, Hazuda HP ,Mitchell BD,Patterson JK. Cardiovascu-
lar risk factors in confirmed prediabeticindividuals. JAMA.1990;263:2893-
Regular aerobic exercise, atleast 150 minutes/week 2998.PubMed
spread over minimum of 3 days should be performed 3. Fuller JH, Shipley MJ, Rose G, Jarrett RJ, Keen H. Coro-
if cardiovascular health permits. nary-heart-disease risk and impaired glucose tolerance: the Whitehall
Study. Lancet.1980;1:1373-1376.PubMed
Behavioural Modification:
4. Tominaga M,Eguchi H,Manaka H, Igarashi K,Kato T,Sekikawa A. Impaired
Individuals require support and coping strategies for glucose tolerance is a risk factor for cardiovascular disease, but not
life style changes including healthy diet, exercise, impaired fasting glucose: the Funagata Diabetes Study. Diabetes
Care.1999;22:920-924.PubMed
weight reduction. Smoking cessation and treatment
compliance and also depression. 5. Temelkova-Kurktschiev TS, Koehler C, Henkel E, Leonhardt W, Fueck-
er K,Hanefeld M. Postchallenge plasma glucose and glycemic spikes are
Weight Loss: more strongly associated with atherosclerosis than fasting glucose or Hb
A level. DiabetesCare.2000;23:1830-1834.PubMed
1c
Weight reduction aimed at 7% weight loss is the COR-
NER STONE OF treatment For ever weight or obese 6. Bonora E,Kiechl S,Oberhollenzer F. et al. Impaired glucose tolerance, type
II diabetes mellitus, and carotid atherosclerosis: prospective results from
individual with prediabetes. the Bruneck Study. Diabetologia.2000;43:156-164.PubMed
Along with other life style modifications, Bariatric sur- 7. Chiasson JL, Gomis R, Hanefeld M, Josse RG, Karasik A, Laakso M.for
gery remains an effective option for obese patients the STOP-NIDDM trial. An international study on the efficacy of an
α-glucosidase inhibitor to prevent type 2 diabetes in a population with
with Type-2 diabetes. impaired glucose tolerance: rationale, design, and preliminary screening
Pharmacological Approach: data. Diabetes Care.1998;21:1720-1725.PubMed

For the patients with multiple risk factors of T2DM
progression where the patient is unable to incor-
porate life style interventions, Metformin use may
be appropriate, although there is some evidence to
suggest that it is less effective for the older popula-
tion. In high risk patients, with prediabetes, diabetes
prevention, life style modification or Metformin has
been demonstrated to be COST effective and even
cost saving. Metformin should not be prescribed for
patients with lower glomerular fitness rate. Acarbose
and glucosIdase inhibitor that blocks the absorption
of dietary carbohydrate, has also been demonstrated
to reduce the progression from impaired glucose tol-
erance to DM. Further it may have favourable effects
on cardiovasdcular event rates. Although thiazoli-
dinediones may also prevent Type 2 Diabetes Mel-
litus, their use for the prevention of DM is debated,
in part because of weight gain and the controversial
effect in cardiovascular event rates with roziglitazone.
Statins have been associated with incidence of Type
2 diabetes, especially among those with prediabe-
tes. However, their cardiovascular benefits are clear

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