[Prediabetes - 2009]

The concept of prediabetes has been discussed since the 1950's. After 1980, WHO expert guidelines on the classification of diabetes according to its stages of development became common. These guidelines also included statistically significant risk groups with diabetes likely to develop in the future. The term Impaired Glucose Tolerance (IGT) was officially introduced by WHO in 1979, with an additional category referring to changes in glucose metabolism to be included later on--the Impaired Fasting Glucose--IFG. The term prediabetes mellitus began to be used again after 2000, and after 2003 diagnostic criteria to delimit diabetes and prediabetes came into use. Progressively, evidence was gathered on the involvement of hyperglycaemia and other metabolic abnormalities in patients with type 2 diabetes in creating conditions for the development of atherosclerosis. The last decade saw re-emerging publications dealing with the abnormalities of glucose metabolism, and subsequent statements from ADA, IDF and other organisations proposing the techniques of screening, diagnosis, monitoring and/or therapy of prediabetes. Recently, the American Diabetes Association clearly specifes the diagnosis of prediabetes, whereby prediabetes is defined within the scope of the diabetic disease. Prediabetes/diabetes reflect the continuum of the risk of microvascular and macrovascular outcomes. For these reasons, methods have been developed to delay the progression of prediabetes to diabetes. An ADA panel suggests that individuals with prediabetes should be enrolled in a program of intensive lifestyle intervention, with a specific group of patients at risk to be considered for therapy with metformin. Additional methods of prevention will be introduced into practice on the basis of new studies.