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Update on pre-diabetes: Focus on diagnostic criteria and cardiovascular risk
Antonino Di Pino1, Francesca Urbano1, Salvatore Piro1
1Antonino Di Pino, Francesca Urbano, Salvatore Piro, Francesco Purrello, Agata Maria Rabuazzo, Department of Clinical and Experimental Medicine, University of Catania, 95122 Catania, Italy.
Insights
Pre-diabetes indicates a high risk for diabetes and cardiovascular disease. This review examines diagnostic methods like impaired fasting glucose, impaired glucose tolerance, and HbA1c, focusing on their predictive value for cardiovascular risks.
Area of Science:
- Endocrinology and Metabolism
- Cardiovascular Medicine
- Clinical Diagnostics
Background:
- Pre-diabetes, characterized by elevated blood glucose, signifies an increased risk for developing type 2 diabetes and cardiovascular disease.
- It encompasses individuals with impaired fasting glucose (IFG), impaired glucose tolerance (IGT), or specific HbA1c levels (39-46 mmol/mol).
- Pre-diabetes is linked to more significant vascular damage than normoglycemia, independent of other risk factors.
Approach:
- This review synthesizes recent research and ongoing debates concerning pre-diabetes diagnosis and its cardiovascular implications.
- It specifically evaluates the diagnostic utility of glycated haemoglobin (HbA1c) for pre-diabetes and cardiovascular risk prediction.
- The review also explores emerging non-traditional glycemic biomarkers as potential complements or alternatives to established methods.
Key Points:
- IFG, IGT, and HbA1c are established predictors of type 2 diabetes risk.
- Concordance between diagnostic methods for pre-diabetes is often low, with conflicting evidence on their respective cardiovascular risk prediction capabilities.
- HbA1c is increasingly used for screening, necessitating a clear understanding of its diagnostic accuracy and prognostic value.
Conclusions:
- Accurate diagnosis of pre-diabetes is crucial for preventing or delaying disease progression and complications.
- Further research is needed to clarify the optimal diagnostic approach and the role of various biomarkers in cardiovascular risk stratification.
- The review underscores the importance of evaluating HbA1c's role in identifying individuals at high risk for both pre-diabetes and associated cardiovascular complications.
Abstract:
Pre-diabetes, which is typically defined as blood glucose concentrations higher than normal but lower than the diabetes threshold, is a high-risk state for diabetes and cardiovascular disease development. As such, it represents three groups of individuals: Those with impaired fasting glucose (IFG), those with impaired glucose tolerance (IGT) and those with a glycated haemoglobin (HbA1c) between 39-46 mmol/mol. Several clinical trials have shown the important role of IFG, IGT and HbA1c-pre-diabetes as predictive tools for the risk of developing type 2 diabetes. Moreover, with regard to cardiovascular disease, pre-diabetes is associated with more advanced vascular damage compared with normoglycaemia, independently of confounding factors. In view of these observations, diagnosis of pre-diabetes is mandatory to prevent or delay the development of the disease and its complications; however, a number of previous studies reported that the concordance between pre-diabetes diagnoses made by IFG, IGT or HbA1c is scarce and there are conflicting data as to which of these methods best predicts cardiovascular disease. This review highlights recent studies and current controversies in the field. In consideration of the expected increased use of HbA1c as a screening tool to identify individuals with alteration of glycaemic homeostasis, we focused on the evidence regarding the ability of HbA1c as a diagnostic tool for pre-diabetes and as a useful marker in identifying patients who have an increased risk for cardiovascular disease. Finally, we reviewed the current evidence regarding non-traditional glycaemic biomarkers and their use as alternatives to or additions to traditional ones.
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