A 48-year-old woman from urban Delhi attends a community health camp organized under NPCDCS. She is asymptomatic but has a family history of type 2 diabetes (mother and brother affected). Fasting blood glucose is 110 mg/dL and HbA1c is 5.8%. Her BMI is 28 kg/m², and she is a non-smoker. The health worker counsels her on diet and physical activity. According to NPCDCS guidelines, what is the most appropriate classification of this woman's glycaemic status and the recommended management strategy?

Explanation

## Glycaemic Classification and NPCDCS Management Strategy ### Interpretation of Glucose Values | Fasting Glucose (mg/dL) | HbA1c (%) | Classification | |---|---|---| | < 100 | < 5.7 | Normal | | 100–125 | 5.7–6.4 | Impaired Fasting Glucose (IFG) | | ≥ 126 | ≥ 6.5 | Type 2 Diabetes Mellitus | **Key Point:** This patient's fasting glucose of 110 mg/dL falls in the IFG range (100–125 mg/dL), and HbA1c of 5.8% is in the prediabetic range (5.7–6.4%). She does NOT meet diagnostic criteria for type 2 diabetes. ### NPCDCS Approach to Prediabetes (IFG/IGT) **High-Yield:** The NPCDCS and WHO guidelines recommend: 1. **Lifestyle modification as first-line intervention** for IFG: - Weight reduction (5–10% if overweight/obese) - Dietary counselling (reduced refined carbohydrates, increased fibre) - Physical activity (150 min/week moderate intensity) - Smoking cessation 2. **Pharmacotherapy is NOT recommended** for isolated IFG in asymptomatic individuals without additional cardiovascular risk factors 3. **Follow-up:** Recheck glucose and HbA1c in **3 years** or earlier if symptoms develop **Clinical Pearl:** This patient has multiple risk factors for diabetes progression: - Family history (mother and brother) - Overweight (BMI 28 kg/m²) - Prediabetic glucose values However, the **Diabetes Prevention Program (DPP)** and subsequent trials show that intensive lifestyle modification reduces progression to diabetes by ~58% in this population. **Mnemonic: IFG Management — LIFESTYLE FIRST, DRUGS LATER** - **L**ifestyle modification (diet, exercise, weight loss) - **I**ntensive counselling - **F**ollow-up in 3 years - **D**rugs only if progression to diabetes or high cardiovascular risk ### Why Metformin is NOT Recommended Here - Metformin is indicated for **type 2 diabetes** or **high-risk prediabetes** (e.g., BMI > 35, age < 60, strong family history, prior GDM) - This patient, while at risk, has not progressed to diabetes and should be given a trial of lifestyle modification first - NPCDCS emphasizes cost-effective, non-pharmacological interventions at the community level [cite:Park 26e Ch 10; Harrison 21e Ch 417]