Impaired glucose regulation: FPG 100–125 mg/dL, 2-h OGTT 140–199, or HbA1c 5.7–6.4%.
Risk factors
- • Obesity
- • Family history T2DM
- • GDM history
- • PCOS
- • Age ≥45
History taking
- • Onset, duration, progression, severity
- • Aggravating / relieving factors
- • Past history, drugs, allergies, comorbidities
- • Family & social history relevant to presentation
Examination
- • General: vitals, pallor, icterus, oedema, lymphadenopathy
- • Focused system examination
- • Look for red-flag findings
Red flags
- • Haemodynamic instability
- • Rapid deterioration
- • Severe pain or new neurological deficit
Differential diagnosis
- • See differentials section per chief complaint
Recommended investigations
- • Repeat FPG / HbA1c to confirm
- • Lipid profile, BP
Diagnosis
- • Clinical diagnosis supported by targeted investigations
Initial treatment / management
- • Lifestyle programme (DPP) — 7% weight loss + 150 min/week activity reduces progression by 58%
Drug therapy
- • Metformin 500 mg BD if BMI ≥35, age <60 or prior GDM
Follow-up advice
- • Annual HbA1c
- • Annual CVD risk assessment
Patient counselling
- • Explain diagnosis and natural course in lay terms
- • Red-flag symptoms warranting urgent return
- • Adherence to medications and follow-up
Referral criteria
- • Refer if diagnostic uncertainty, complications, or failure of first-line therapy
Clinical pearls
- • ~30% progress to T2DM within 5 years without intervention
References
- • Harrison's Principles of Internal Medicine, 21e
- • NICE / WHO guidelines (current edition)
Educational outpatient guide — verify against local guidelines before clinical use.
