[Intolerance to carbohydrates: the seven questions]

Area of Science:

• Endocrinology
• Metabolic Disorders
• Clinical Diagnostics

Context:

• The distinction between diabetes and carbohydrate intolerance relies on glycaemic thresholds for microangiopathy risk.
• The boundary between carbohydrate intolerance and normal glucose tolerance is arbitrary, with many individuals normalizing over time.
• Carbohydrate intolerance is a heterogeneous condition influenced by insulin deficiency and resistance.

Purpose:

• To explore the limitations of current diagnostic methods for carbohydrate intolerance.
• To investigate the role of insulin secretion and resistance in predicting non-insulin-dependent diabetes.
• To evaluate alternative markers for assessing vascular risk associated with glucose metabolism.

Summary:

• Alterations in insulin secretion are key indicators of susceptibility to non-insulin-dependent diabetes.
• Insulin resistance is a primary driver of insulin secretion exhaustion, leading to diabetes.
• Insulin resistance and resultant hyperinsulinism may promote atherogenesis even with normal glucose tolerance.
• Standard oral glucose tolerance tests have limitations in reproducibility and early vascular risk detection.
• Fasting/post-prandial glucose, HbA1C, lipids, and HDL cholesterol aid in risk stratification.
• Measuring blood insulin levels may offer better atherogenesis risk assessment, pending clinical validation.

Impact:

• Refining diagnostic criteria for carbohydrate intolerance and diabetes.
• Improving early detection of individuals at risk for type 2 diabetes and cardiovascular complications.
• Guiding clinical practice towards more accurate assessment of metabolic and vascular risks.