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JAMA Apr 2023Prediabetes, an intermediate stage between normal glucose regulation and diabetes, affects 1 in 3 adults in the US and approximately 720 million individuals worldwide. (Meta-Analysis)
Meta-Analysis Review
IMPORTANCE
Prediabetes, an intermediate stage between normal glucose regulation and diabetes, affects 1 in 3 adults in the US and approximately 720 million individuals worldwide.
OBSERVATIONS
Prediabetes is defined by a fasting glucose level of 100 to 125 mg/dL, a glucose level of 140 to 199 mg/dL measured 2 hours after a 75-g oral glucose load, or glycated hemoglobin level (HbA1C) of 5.7% to 6.4% or 6.0% to 6.4%. In the US, approximately 10% of people with prediabetes progress to having diabetes each year. A meta-analysis found that prediabetes at baseline was associated with increased mortality and increased cardiovascular event rates (excess absolute risk, 7.36 per 10 000 person-years for mortality and 8.75 per 10 000 person-years for cardiovascular disease during 6.6 years). Intensive lifestyle modification, consisting of calorie restriction, increased physical activity (≥150 min/wk), self-monitoring, and motivational support, decreased the incidence of diabetes by 6.2 cases per 100 person-years during a 3-year period. Metformin decreased the risk of diabetes among individuals with prediabetes by 3.2 cases per 100 person-years during 3 years. Metformin is most effective for women with prior gestational diabetes and for individuals younger than 60 years with body mass index of 35 or greater, fasting plasma glucose level of 110 mg/dL or higher, or HbA1c level of 6.0% or higher.
CONCLUSIONS AND RELEVANCE
Prediabetes is associated with increased risk of diabetes, cardiovascular events, and mortality. First-line therapy for prediabetes is lifestyle modification that includes weight loss and exercise or metformin. Lifestyle modification is associated with a larger benefit than metformin.
Topics: Adult; Female; Humans; Blood Glucose; Diabetes Mellitus; Glycated Hemoglobin; Metformin; Prediabetic State; Risk Factors; United States; Cardiometabolic Risk Factors; Risk Reduction Behavior; Healthy Lifestyle; Health Behavior
PubMed: 37039787
DOI: 10.1001/jama.2023.4063 -
Journal of Clinical Research in... Dec 2017The Metabolic syndrome describes a clustering of typical cardiovascular risk factors. The syndrome is also known as "Insulin Resistance syndrome" as a substantial part... (Review)
Review
The Metabolic syndrome describes a clustering of typical cardiovascular risk factors. The syndrome is also known as "Insulin Resistance syndrome" as a substantial part of the pathophysiology is driven by resistance to the metabolic effects of insulin. The major cause of insulin resistance in childhood is a typical lipid partitioning pattern characterized by increased deposition of lipids within insulin responsive tissues, such as the liver and skeletal muscle and within the viscera. This lipid deposition pattern is also associated with infiltration of intra-abdominal tissues with cells of the immune system, inducing systemic, low-grade inflammation typically observed in insulin resistant obese children and adolescents. Several clues derived from a careful history and physical examination, along with a basic laboratory workup, provide clues in regards to risk stratification in obese children.
Topics: Child; Female; Humans; Insulin Resistance; Male; Metabolic Syndrome; Pediatricians; Pediatrics; Prediabetic State
PubMed: 29280741
DOI: 10.4274/jcrpe.2017.S005 -
Canadian Journal of Diabetes Apr 2018
Topics: Diabetes Mellitus; Humans; Metabolic Syndrome; Practice Guidelines as Topic; Prediabetic State
PubMed: 29650080
DOI: 10.1016/j.jcjd.2017.10.003 -
JAMA Apr 2023
Topics: Humans; Blood Glucose; Prediabetic State
PubMed: 37039802
DOI: 10.1001/jama.2023.4406 -
Journal of Cardiovascular Pharmacology... 2022The obesity pandemic is accompanied by increased risk of developing metabolic syndrome (MetS) and related conditions: non-alcoholic fatty liver disease... (Review)
Review
Glucagon-Like Peptide-1 Receptor Agonists and Dual Glucose-Dependent Insulinotropic Polypeptide/Glucagon-Like Peptide-1 Receptor Agonists in the Treatment of Obesity/Metabolic Syndrome, Prediabetes/Diabetes and Non-Alcoholic Fatty Liver Disease-Current Evidence.
The obesity pandemic is accompanied by increased risk of developing metabolic syndrome (MetS) and related conditions: non-alcoholic fatty liver disease (NAFLD)/non-alcoholic steatohepatitis (NASH), type 2 diabetes mellitus (T2DM) and cardiovascular (CV) disease (CVD). Lifestyle, as well as an imbalance of energy intake/expenditure, genetic predisposition, and epigenetics could lead to a dysmetabolic milieu, which is the cornerstone for the development of cardiometabolic complications. Glucagon-like peptide-1 (GLP-1) receptor agonists (RAs) and dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 RAs promote positive effects on most components of the "" and consequently help reduce the need for polypharmacy. In this review, we highlight the main pathophysiological mechanisms and risk factors (RFs), that could be controlled by GLP-1 and dual GIP/GLP-1 RAs independently or through synergism or differences in their mode of action. We also address the evidence on the use of GLP-1 and dual GIP/GLP-1 RAs in the treatment of obesity, MetS and its related conditions (prediabetes, T2DM and NAFLD/NASH). In conclusion, GLP-1 RAs have already been established for the treatment of T2DM, obesity and cardioprotection in T2DM patients, while dual GIP/GLP-1 RAs appear to have the potential to possibly surpass them for the same indications. However, their use in the prevention of T2DM and the treatment of complex cardiometabolic metabolic diseases, such as NAFLD/NASH or other metabolic disorders, would benefit from more evidence and a thorough clinical patient-centered approach. There is a need to identify those patients in whom the metabolic component predominates, and whether the benefits outweigh any potential harm.
Topics: Humans; Non-alcoholic Fatty Liver Disease; Diabetes Mellitus, Type 2; Glucagon-Like Peptide-1 Receptor; Metabolic Syndrome; Prediabetic State; Glucagon-Like Peptide 1; Obesity; Glucose; Peptides
PubMed: 36546652
DOI: 10.1177/10742484221146371 -
Metabolic Syndrome and Related Disorders May 2023The metabolic syndrome (MetS) is a cluster of risk factors for cardiovascular disease (CVD). Prediabetes is defined by either impaired glucose tolerance or by one of the... (Review)
Review
The metabolic syndrome (MetS) is a cluster of risk factors for cardiovascular disease (CVD). Prediabetes is defined by either impaired glucose tolerance or by one of the more sensitive or more stringent criterion for impaired fasting glucose (IFG) or HbA1c levels that have been promulgated over the years. IFG is one of the risk factors for CVD included in the definition of the MetS. However, there is very little evidence that IFG is independently associated with CVD regardless of which criterion is used for its diagnosis. The CVD risk of the MetS is related to the other risk factors of central obesity, hypertension, elevated triglyceride, and low high-density lipoprotein cholesterol levels. If the components of the MetS are supposed to be risk factors for CVD, the dysglycemia of prediabetes should not be included in its definition.
Topics: Humans; Metabolic Syndrome; Prediabetic State; Risk Factors; Glucose Intolerance; Cardiovascular Diseases; Blood Glucose
PubMed: 37042661
DOI: 10.1089/met.2023.0005 -
Wiener Klinische Wochenschrift May 2019Diabetes mellitus comprises a group of heterogeneous disorders, which have an increase in blood glucose concentrations in common. The current classification for... (Review)
Review
Diabetes mellitus comprises a group of heterogeneous disorders, which have an increase in blood glucose concentrations in common. The current classification for diabetes mellitus is presented and the main features of type 1 and type 2 diabetes are compared. Furthermore, the criteria for the correct biochemical diagnosis during fasting and oral glucose tolerance tests as well as the use of hemoglobin A1c (HbA1c) are summarized. The increasing prevalence of diabetes requires targeted screening for detecting diabetes and prediabetes in risk groups. This forms the basis for the early initiation of measures to prevent the onset of diabetes in these risk groups and to delay the progression of diabetes.
Topics: Blood Glucose; Diabetes Mellitus; Fasting; Glucose Tolerance Test; Glycated Hemoglobin; Humans; Practice Guidelines as Topic; Prediabetic State; Terminology as Topic
PubMed: 30980151
DOI: 10.1007/s00508-019-1450-4 -
Endocrinology and Metabolism Clinics of... Mar 2018Prediabetes is a state characterized by impaired fasting glucose or impaired glucose tolerance. This review discusses the pathophysiology and macrovascular complications... (Review)
Review
Prediabetes is a state characterized by impaired fasting glucose or impaired glucose tolerance. This review discusses the pathophysiology and macrovascular complications of prediabetes. The pathophysiologic defects underlying prediabetes include insulin resistance, alpha- and beta-cell dysfunction, increased lipolysis, inflammation, and suboptimal incretin effect. Recent studies have revealed that the long-term complications of diabetes manifest in some people with prediabetes; these complications include microvascular and macrovascular disorders. Finally, we present an overview of randomized control trials aimed at preventing progression from prediabetes to type 2 diabetes and discuss their implications for macrovascular risk reduction.
Topics: Cardiovascular Diseases; Diabetes Mellitus, Type 2; Disease Progression; Humans; Prediabetic State; Risk Reduction Behavior
PubMed: 29407055
DOI: 10.1016/j.ecl.2017.10.001 -
Current Medical Research and Opinion Sep 2019Prediabetes is defined as a state of abnormal glucose homeostasis where blood glucose levels are elevated above those considered normal, but not as high as those... (Review)
Review
Prediabetes is defined as a state of abnormal glucose homeostasis where blood glucose levels are elevated above those considered normal, but not as high as those required for a diagnosis of diabetes. As a condition intermediate between normal glucose homeostasis and the pathological condition of diabetes, the characterization of prediabetes as a distinct pathogenic condition is controversial. Emerging evidence suggests that the condition of prediabetes is associated with pathophysiological changes in several tissues and organs, which would support its recognition as a distinct pathological entity; the recent inclusion of prediabetes and associated billable conditions in the most recent ICD-10 codes provides additional credence to this position. This minireview summarizes our understanding of prediabetes and provides evidence that it should be considered a distinct and important clinical entity.
Topics: Blood Glucose; Cost of Illness; Humans; Life Style; Prediabetic State; Prevalence
PubMed: 30935247
DOI: 10.1080/03007995.2019.1601455 -
Minerva Medica Feb 2019Prediabetes is the subclinical impairment in fasting plasma glucose, impaired glucose tolerance or both. The degree of impairment is between euglycemia and the... (Review)
Review
Prediabetes is the subclinical impairment in fasting plasma glucose, impaired glucose tolerance or both. The degree of impairment is between euglycemia and the hyperglycemia of type 2 diabetes (T2DM). Prediabetes is not considered benign, because it is a risk factor for T2DM but is also associated with micro and macrovascular complications. Lifestyle interventions including diet and exercise are first-line treatments. Medications can also play a role, as randomized controlled trials of biguanides (metformin) alpha-glucosidase inhibitors (Acarbose), inhibitors of pancreatic lipase (Orlistat), PPAR-gamma agonists (Rosiglitazone, Pioglitazone), meglitinides (Nateglinide) and GLP-1 receptor agonists (Liraglutide) have all shown benefits. Bariatric surgery is another efficacious means of preventing T2DM in patients with prediabetes and obesity. Prediabetes in its various guises is a risk factor for the future development T2DM and diabetic complications. Importantly the prediabetic state is amenable to interventions that prevent/delay transition to overt T2DM. Knowledge gaps exist regarding how best to make prognostication highly sensitive and specific as to which patient will develop T2DM. Moreover, understanding of phenotype specific pathophysiology may add value to funding appropriate interventions for patients with prediabetes. Management of patients with prediabetes should be individualized based on the algorithms that predict phenotype specific risk and allow for the use of phenotype tailored interventions.
Topics: Diabetes Mellitus, Type 2; Humans; Prediabetic State
PubMed: 30371047
DOI: 10.23736/S0026-4806.18.05897-4