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Should Prediabetes Be Classified as a Treatable Disease?
William E Winter1, Ishwarlal Jialal2
1Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL 32610, USA.
Insights
Prediabetes affects 21% of the global population and significantly increases the risk of type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). Intensive lifestyle interventions and metformin therapy can effectively prevent T2DM progression.
Area of Science:
- Endocrinology
- Public Health
- Metabolic Disorders
Background:
- Prediabetes represents a critical global health issue, affecting approximately 21% of the world's population.
- It serves as a precursor stage to type 2 diabetes mellitus (T2DM), significantly elevating the risk of cardiovascular disease (CVD).
Purpose of the Study:
- To highlight the global burden and clinical significance of prediabetes.
- To emphasize the importance of early diagnosis and effective management strategies for prediabetes.
Main Methods:
- Diagnosis relies on accessible and cost-effective plasma glucose and/or hemoglobin A1c (HbA1c) measurements.
- Treatment focuses on intensive lifestyle (ILS) interventions, including dietary changes and regular physical activity.
- Metformin therapy is also recognized as a preventive measure against T2DM progression.
Main Results:
- Intensive lifestyle intervention, including a 5% weight loss, has demonstrated efficacy in reducing T2DM progression in numerous global studies.
- Metformin has been proven effective in preventing the transition from prediabetes to T2DM.
- Prediabetes is linked to serious complications such as T2DM and CVD.
Conclusions:
- Given its global impact, diagnostic accessibility, associated risks, and effective interventions, classifying prediabetes as a disease warrants serious consideration by guideline committees.
- Targeted therapy is recommended for high-risk individuals, including those with impaired glucose tolerance (IGT), impaired fasting glucose (IFG) ≥ 110 mg/dL, and/or HbA1c ≥ 6.0%, especially when combined with overweight or obesity.
Abstract:
Prediabetes is a serious and major global problem afflicting approximately 21% of the world's population. It is the intermediate stage between normal glucose levels and type 2 diabetes mellitus (T2DM). Prediabetes is associated with major complications including the development of T2DM and increased cardiovascular disease (CVD). It can be easily diagnosed with an inexpensive plasma glucose level and/or a hemoglobin A1c (HbA1c) measurement. The mainstay of treatment is intensive lifestyle (ILS) intervention, including reduction in calories, especially saturated fats, refined carbohydrates, etc., coupled with regular physical activity of 150 min per week since ILS changes, with at least a 5% weight loss, have been shown to reduce progression to T2DM in multiple studies globally. Also, metformin therapy has been shown to prevent the progression to T2DM. In conclusion, serious consideration by guideline committees to classify prediabetes as a disease is highly recommended based on its global burden, easy and cost-effective diagnosis, association with serious conditions of diabetes and CVD, and effective ILS intervention. Therapy targeting those at an especially high risk for T2DM, such as persons with impaired glucose tolerance (IGT), impaired fasting glucose (IFG) with values ≥ 110 mg/dL (6.1 mmol/L), and/or HbA1c ≥ 6.0% (42 mmol/mol) coupled with overweightness or obesity.
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