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Treating prediabetes: why and how should we do it?

Tassia Braga¹, Luiz G Kraemer-Aguiar², Neil G Docherty³

¹UERJ, Rio de Janeiro, Brazil - tassiabraga@msn.com.

|October 30, 2018

Summary

Prediabetes indicates impaired glucose levels, increasing type 2 diabetes (T2DM) risk and complications. Interventions like lifestyle changes, medications, and surgery can prevent or delay T2DM progression.

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Area of Science:

Endocrinology
Metabolic Disorders
Public Health

Background:

Prediabetes is a subclinical glucose metabolism impairment, bridging normal glucose levels and type 2 diabetes (T2DM).
It is a significant risk factor for T2DM development and associated micro/macrovascular complications.
The prediabetic state is a critical window for interventions to prevent or delay overt T2DM.

Purpose of the Study:

To review the current understanding of prediabetes management and its role in T2DM prevention.
To highlight the efficacy of various interventions, including lifestyle modifications, pharmacotherapy, and bariatric surgery.
To identify knowledge gaps in prognostication and phenotype-specific pathophysiology for tailored interventions.

Main Methods:

Review of randomized controlled trials and established treatment guidelines for prediabetes.
Analysis of pharmacological interventions including biguanides, alpha-glucosidase inhibitors, and GLP-1 receptor agonists.
Evaluation of lifestyle interventions (diet, exercise) and bariatric surgery as T2DM prevention strategies.

Main Results:

Lifestyle interventions (diet, exercise) are primary treatments for prediabetes.
Several medications (metformin, acarbose, orlistat, rosiglitazone, pioglitazone, nateglinide, liraglutide) have demonstrated benefits in preventing T2DM.
Bariatric surgery is highly effective in T2DM prevention for obese patients with prediabetes.

Conclusions:

Prediabetes is a modifiable risk factor for T2DM and its complications, amenable to timely interventions.
Individualized management, guided by risk prediction algorithms and phenotype-specific approaches, is crucial.
Further research is needed to refine prognostication accuracy and understand phenotype-specific pathophysiology to optimize interventions.