eMedicine Specialties > Endocrinology > Diabetes Mellitus

Glucose Intolerance: Follow-up

Author: Samuel T Olatunbosun, MD, FACP, Chief, Internal Medicine, 56th Medical Group, Luke Air Force Base
Coauthor(s): Samuel Dagogo-Jack, MD, MBBS, MSc, FRCP, Professor of Medicine, Program Director, Division of Endocrinology, Diabetes and Metabolism, University of Tennessee Health Science Center
Contributor Information and Disclosures

Updated: Aug 5, 2009

Follow-up

Further Inpatient Care

  • Admit for treatment and close monitoring during severe acute decompensation.

Further Outpatient Care

  • Monitoring of medication compliance and adverse effects
  • Blood glucose and HbA1C monitoring
  • Dietary consultation
  • Dietary measures and exercise

Inpatient & Outpatient Medications

  • Medications include sulfonylureas, meglitinides, biguanides and thiazolidinediones, alpha-glucosidase inhibitors, and insulin preparations, sometimes in combination.
  • Carefully select medications that are beneficial in the context of comorbid states.

Transfer

  • Transfer to a specialist for further evaluation and treatment if specific problems cannot be managed effectively at the primary care level or in the event that glucose intolerance worsens despite the best efforts to control it.

Deterrence/Prevention

  • Avoid dietary indiscretion.
  • Avoid physical inactivity.
  • Quit or avoid smoking.
  • Avoid ethanol abuse.

Complications

  • Impaired glucose tolerance (IGT) and diabetes - Coronary artery disease
  • IGT and diabetes - Peripheral vascular disease
  • IGT and diabetes - Stroke
  • Diabetes - Nephropathy
  • Diabetes - Retinopathy
  • Diabetes - Neuropathy
  • Diabetes - Acute metabolic complications

Prognosis

  • Impaired glucose tolerance (IGT) is a risk factor for type 2 diabetes, with 20-50% of individuals with IGT developing type 2 diabetes over 10 years. Approximately one third revert to normal glucose tolerance, while others persistently demonstrate IGT, as determined using the OGTT.
  • For gestational diabetes mellitus, reclassification is performed at 6 weeks or more postpartum. In most patients with gestational diabetes mellitus, glucose tolerance becomes normal after delivery. However, the lifetime risk for IGT and diabetes is increased substantially in these women.

Patient Education

  • Educate patients on the disease, treatment, monitoring, complications, and primary and secondary preventive measures.
  • Educate family members on various issues, including the management of hypoglycemia.
  • For excellent patient education resources, visit eMedicine's Diabetes Center. Also, see eMedicine's patient education articles Diabetes and Diabetic Eye Disease.

Miscellaneous

Medicolegal Pitfalls

  • Failure to recognize an association with major medical disorders, such as hypertension, dyslipidemia, and coronary artery disease
  • Failure to treat comorbid conditions
  • Failure to inform the patient of potentially serious adverse effects that may occur with the use of some antihyperglycemic agents
  • Failure to inform the patient of the possibility of disease progression and the development of complications

Special Concerns

  • Increased glucose tolerance (IGT) and impaired fasting glucose do not imply normality, but they do not carry the stigma and connotations of the term diabetes.
 


More on Glucose Intolerance

Overview: Glucose Intolerance
Differential Diagnoses & Workup: Glucose Intolerance
Treatment & Medication: Glucose Intolerance
Follow-up: Glucose Intolerance
Multimedia: Glucose Intolerance
References
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Further Reading

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Keywords

glucose intolerance, abnormal glucose tolerance, abnormal glucose homeostasis, disorders of glucose tolerance, disorders of glycemia, glucose tolerance, type 1 diabetes mellitus, type 2 diabetes mellitus, gestational diabetes mellitus, GDM, impaired glucose tolerance, IGT, impaired fasting glucose, IFG, insulin resistance, hyperglycemia, normoglycemia, ketoacidosis, dysmetabolic syndrome, central adiposity, pancreas, pancreatic function, hypoglycemia, pancreatic beta cells

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Contributor Information and Disclosures

Author

Samuel T Olatunbosun, MD, FACP, Chief, Internal Medicine, 56th Medical Group, Luke Air Force Base
Samuel T Olatunbosun, MD, FACP is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Physicians-American Society of Internal Medicine, and American Diabetes Association
Disclosure: Nothing to disclose.

Coauthor(s)

Samuel Dagogo-Jack, MD, MBBS, MSc, FRCP, Professor of Medicine, Program Director, Division of Endocrinology, Diabetes and Metabolism, University of Tennessee Health Science Center
Samuel Dagogo-Jack, MD, MBBS, MSc, FRCP is a member of the following medical societies: American College of Physicians, American Diabetes Association, American Federation for Medical Research, Endocrine Society, and Royal College of Physicians
Disclosure: Eli Lilly None Speaking and teaching; GlaxoSmithKline None Speaking and teaching; Merck None Speaking and teaching

Medical Editor

David S Schade, MD, Chief, Division of Endocrinology and Metabolism, Professor, Department of Internal Medicine, University of New Mexico School of Medicine and Health Sciences Center
David S Schade, MD is a member of the following medical societies: American College of Physicians, American Diabetes Association, American Federation for Medical Research, Endocrine Society, New Mexico Medical Society, New York Academy of Sciences, and Society for Experimental Biology and Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Don S Schalch, MD, Professor Emeritus, Department of Internal Medicine, Division of Endocrinology, University of Wisconsin Hospitals and Clinics
Don S Schalch, MD is a member of the following medical societies: American Diabetes Association, American Federation for Medical Research, Central Society for Clinical Research, and Endocrine Society
Disclosure: Nothing to disclose.

CME Editor

Mark Cooper, MBBS, PhD, FRACP, Head, Diabetes & Metabolism Division, Baker Heart Research Institute, Professor of Medicine, Monash University
Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD, Professor of Medicine, St Louis University School of Medicine
George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Medical Practice Executives, American College of Physician Executives, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical Research, Endocrine Society, International Society for Clinical Densitometry, and Southern Society for Clinical Investigation
Disclosure: Nothing to disclose.

 
 
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