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Prediabetes.

Aditya K Khetan1, Sanjay Rajagopalan1

  • 1Harrington Heart and Vascular Institute, Division of Cardiovascular Medicine, Cleveland, Ohio, USA.

The Canadian Journal of Cardiology
|May 8, 2018
PubMed
Summary

Preventing type 2 diabetes is crucial as cases rise globally. Intensive lifestyle changes are the preferred treatment for prediabetes, effectively reducing diabetes progression and mortality. Metformin is the leading drug therapy.

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Area of Science:

  • Endocrinology
  • Metabolic Diseases
  • Public Health

Background:

  • Global diabetes prevalence is projected to increase significantly, with prediabetes being a common precursor.
  • Key pathophysiological factors in prediabetes include insulin resistance, impaired incretin action, and insulin hypersecretion.
  • Screening for diabetes using fasting plasma glucose and/or hemoglobin A1c is recommended for individuals over 40 and those at high risk.

Purpose of the Study:

  • To review the pathophysiology of prediabetes.
  • To discuss screening and treatment strategies for prediabetes.
  • To evaluate the efficacy of various interventions in preventing diabetes progression and achieving remission.

Main Methods:

  • Review of existing literature on prediabetes pathophysiology, screening, and treatment.
  • Analysis of data on the effectiveness of lifestyle interventions and pharmacological agents.
  • Consideration of bariatric surgery for specific patient groups.

Main Results:

  • Intensive lifestyle intervention is the preferred approach for prediabetes, demonstrating reduced progression to diabetes and long-term all-cause mortality.
  • Metformin shows the strongest evidence as a pharmacological treatment for prediabetes.
  • Other agents like GLP-1 agonists and DPP-4 inhibitors show promise, but only metformin is currently recommended.

Conclusions:

  • Restoring normoglycemia in prediabetes can lead to lasting remission.
  • Intensive lifestyle intervention is highly effective in managing prediabetes and improving overall health outcomes.
  • While several drugs show efficacy, metformin remains the primary recommended pharmacological treatment for prediabetes.

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