New University of Otago (Wellington) research shows it could also be more effective at preventing type 2 diabetes.
Medical researcher and lead author Dr Christine Barthow said New Zealand’s "one-size-fits-all’’ approach to prediabetes did not reflect the variable rate at which different groups progressed to type 2 diabetes.
Prediabetes affected 21%-26% of adults, and Māori and Pacific populations were disproportionately represented in this group, she said.
"Despite the large number of people affected, the associated health risks from prediabetes are multifaceted, highly variable and not fully understood for New Zealand populations.’’
An estimated 5% of adults with prediabetes went on to develop type 2 diabetes over a three-year period.
Men, younger people and those with higher blood glucose and body mass index (BMI) levels were most at risk of their condition progressing.
Those aged 35-44 years old were three times more likely to develop type 2 diabetes than those aged over 65, she said.
The New Zealand guidelines for prediabetes recommend health-care providers offer lifestyle modification advice, consider prescribing metformin to reduce blood glucose levels and actively manage cardiovascular disease risk factors.
While the detection of prediabetes provided an early opportunity to intervene to prevent or delay the onset of type 2 diabetes, the present guidelines and the funding models for primary care failed to take into account the higher risk faced by some population groups, Dr Barthow said.
"Our current approach creates an unnecessary burden on the primary health care sector for too little gain.
"Māori and Pacific peoples are particularly poorly served and yet have high health needs in this area.’’
Health-care providers could find it a challenge to identify which patients were most likely to progress to type 2 diabetes and were sometimes uncertain about when and how to intervene effectively, she said.
A co-author and Te Whatu Ora Health New Zealand Capital, Coast and Hutt Valley endocrinologist Prof Jeremy Krebs said other factors contributing to type 2 diabetes in high-risk groups were food insecurity, poverty and unemployment, which could not be addressed through the health system.
They must be tackled at a governmental level, he said.
"To really make a significant difference to the rates of type 2 diabetes, there needs to be well resourced and sustained efforts at multiple levels.’’
Dr Barthow said the guidelines needed to be reviewed and updated to reflect the latest evidence about those most at risk of developing type 2 diabetes.
It was recommended they focus on the risks for younger people; target interventions to higher risk groups; and add guidelines for prescribing metformin.
"They also recommend developing New Zealand-specific risk assessment tools to determine who should be prioritised for prediabetes and diabetes screening and which groups would most benefit from more intensive diabetes prevention support, to ensure limited health care resources are directed to those most in need.’’
