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European Journal of Pharmacology Dec 2011The incidence of diabetes is continuously increasing worldwide. Pre-diabetes (defined as impaired glucose tolerance, impaired fasting glucose or both) represents an... (Review)
Review
The incidence of diabetes is continuously increasing worldwide. Pre-diabetes (defined as impaired glucose tolerance, impaired fasting glucose or both) represents an intermediate state, which often progresses to overt diabetes within a few years. In addition, pre-diabetes may be associated with increased risk of microvascular and macrovascular complications. Thus, reverting a pre-diabetic state as well as preventing the development of diabetes represents enormous challenge for the clinician. Lifestyle modification in pre-diabetic individuals was found particularly effective in the prevention of diabetes. However, compliance to lifestyle modification measures can be a crucial problem in the everyday clinical practice, especially in developing countries. During the last decade many studies support the use of anti-diabetic treatment schemes in pre-diabetic subjects to be advantageous. The American Diabetes Prevention Program (DPP) as well as other minor studies and meta-analyses has convincingly demonstrated the efficacy of metformin in this patient group. In addition, results of the 10 year DPP follow up have recently been published, demonstrating the long term safety and sustainability of metformin treatment benefits in this population. In contrast to metformin, the evidence from the use of other anti-diabetic agents (thiazolidinediones, a-glucosidase inhibitors, incretin mimetics) in pre-diabetic individuals is rather inadequate and prospective data is further needed. Furthermore, large scale studies with hard clinical endpoints are needed to delineate the effect of pre-diabetes treatment on macro- and microvascular complications. In conclusion, several strategies of patient management, mainly lifestyle modification and pharmacological interventions can prevent diabetes development in subjects diagnosed with pre-diabetes or even revert pre-diabetic state. However, whether this biochemical improvement can be translated into actual clinical benefit remains to be established.
Topics: Animals; Biomimetic Materials; Glucagon-Like Peptide 1; Humans; Hypoglycemic Agents; Incretins; Life Style; Prediabetic State
PubMed: 22020287
DOI: 10.1016/j.ejphar.2011.10.007 -
Journal of the Indian Medical... Jan 2007
Topics: Diabetes Mellitus, Type 2; Health Behavior; Humans; India; Insulin Resistance; Life Style; Patient Education as Topic; Prediabetic State
PubMed: 17802968
DOI: No ID Found -
Current Diabetes Reports Feb 2003Type 2 diabetes mellitus is a chronic insidious process contributing to an overwhelming amount of morbidity and mortality, much of which is related to atherosclerosis,... (Review)
Review
Type 2 diabetes mellitus is a chronic insidious process contributing to an overwhelming amount of morbidity and mortality, much of which is related to atherosclerosis, which often accompanies and complicates the natural history of diabetes. Although considerable attention has focused on new insights into diabetic mechanisms and emerging treatments, perhaps one of the greatest opportunities for decreasing the toll of diabetes and its late-stage complications may be intervening earlier in the disease process. Such notions redirect attention toward the concept of prediabetes mellitus as a potentially discrete syndrome, which may be identifiable in clinical practice. This article seeks to offer support for this hypothesis by considering the data surrounding prediabetes mellitus, with particular attention on the mechanistic and clinical links to atherosclerosis.
Topics: Arteriosclerosis; Coronary Disease; Diabetes Mellitus, Type 2; Humans; Metabolic Syndrome; Prediabetic State
PubMed: 12643141
DOI: 10.1007/s11892-003-0047-4 -
Cardiovascular Diabetology May 2024There is conflicting evidence whether prediabetes is associated with adverse clinical outcomes in patients with chronic coronary syndrome. We aimed to assess the effect... (Clinical Trial)
Clinical Trial
BACKGROUND
There is conflicting evidence whether prediabetes is associated with adverse clinical outcomes in patients with chronic coronary syndrome. We aimed to assess the effect of prediabetes in patients with chronic coronary syndrome on clinical outcomes.
METHODS
This is a secondary analysis of data from the ISCHEMIA and ISCHEMIA-CKD trials, including patients with chronic coronary syndrome determined by coronary computed tomography angiography or exercise-stress testing. Participants were assigned to the normoglycemia group (HbA1c < 5.7% [< 39 mmol/mol]), prediabetes group (HbA1c 5.7-6.4% [40-47 mmol/mol]), or diabetes group (HbA1c ≥ 6.5% [≥ 48 mmol/mol]). The primary end point of this study was all-cause mortality. Secondary endpoints included major adverse cardiovascular events and composites thereof.
RESULTS
Overall, the primary endpoint all-cause mortality occurred in 330 (8.4%) of 3910 patients over a median follow-up time of 3.1 years (IQR 2.1-4.1). The primary endpoint all-cause mortality occurred in 37 (5.2%) of 716 patients in the normoglycemia group, in 63 (6.9%) of 911 in the prediabetes group, and in 230 (10.1%) of 2283 in the diabetes group. In the covariate-adjusted Cox model analysis, the estimated adjusted HR (aHR) in the prediabetes group as compared with the normoglycemia group was 1.45 (95%CI, 0.95-2.20). The aHR in the diabetes group as compared with the normoglycemia group was 1.84 (95%CI, 1.29-2.65). Prediabetes, compared with normoglycemia, was associated with an increased risk of stroke (aHR, 3.44, 95%CI, 1.15-10.25). Subgroup analyses suggested an increased risk of all-cause death associated with prediabetes in males and patients under 65 years.
CONCLUSIONS
In patients with chronic coronary syndrome, diabetes but not prediabetes was associated with significantly increased risk of all-cause death within a median follow-up period of 3.1 years. Trial Registration NCT01471522, BioLINCC ID 13936.
Topics: Aged; Female; Humans; Male; Middle Aged; Biomarkers; Blood Glucose; Cause of Death; Chronic Disease; Computed Tomography Angiography; Coronary Angiography; Exercise Test; Glycated Hemoglobin; Prediabetic State; Prognosis; Randomized Controlled Trials as Topic; Risk Assessment; Risk Factors; Time Factors
PubMed: 38769562
DOI: 10.1186/s12933-024-02232-z -
Kardiologiia 2007The state of prediabetes comprises two types of impairment of carbohydrate metabolism: impaired fasting glycemia and impaired glucose tolerance. According to... (Review)
Review
The state of prediabetes comprises two types of impairment of carbohydrate metabolism: impaired fasting glycemia and impaired glucose tolerance. According to International Diabetes Federation at present number of patients with prediabtes is almost 2 times greater than that of patients with diabetes. Risk of development of diabetes and cardiovascular complications in patients with prediabtes is 2 times higher than in persons with normal blood glucose level. Impaired glucose tolerance is also one of main components of metabolic syndrome. For prevention of risk of development of diabetes and cardiovascular complications besides life style changes it is necessary to influence insulin resistance and normalize carbohydrate metabolism. When life style changes are ineffective the use of antihyperglycemic drugs is essential. Antihyperglycemic preparations metformin, acarbose, thiazolidinediones do not affect function of pancreatic beta-cells and do not cause hypoglycaemia. This allows to use these drugs in patients without diabetes but having insulin resistance and prediabetes. Therapeutic effect of metformin and rosiglitazone is related to improvement of sensitivity to insulin in insulin dependent tissues, suppression of glyconeogenesis in the liver, and enhancement of pancreatic beta-cells function. Action of acarbose is based on local inhibition of intestinal enzyme alpha-glycosidase, what leads to diminishment of postprandial hyperglycemia peak. Results of DPP, STOP-NIDDM and DREAM trials have demonstrated high efficacy of antihyperglycemic preparations in prevention of type 2 diabetes.
Topics: Blood Glucose; Humans; Hypoglycemic Agents; Metabolic Syndrome; Prediabetic State; Prognosis; Risk Factors
PubMed: 18260885
DOI: No ID Found -
Frontiers in Endocrinology 2023
Topics: Humans; Prediabetic State; Cardiovascular Diseases; Diabetes Mellitus, Type 2; Blood Glucose; Risk Assessment
PubMed: 37251678
DOI: 10.3389/fendo.2023.1214479 -
Experimental and Clinical Endocrinology... Jul 2006The metabolic syndrome (MetS) is a cluster of risk factors related to cardiovascular disease. Prediabetes, identified by impaired fasting glucose and/or impaired glucose... (Comparative Study)
Comparative Study
OBJECTIVE
The metabolic syndrome (MetS) is a cluster of risk factors related to cardiovascular disease. Prediabetes, identified by impaired fasting glucose and/or impaired glucose tolerance, may predict future development of diabetes mellitus. However, it is not clear whether MetS and prediabetes represent the same or different clinical entities. This study compares MetS and prediabetes in terms of cardiovascular risk factors and target organ damage.
RESEARCH DESIGN AND METHODS
A total of 524 overweight and obese (body mass index, BMI >or= 27 kg/m (2)) adults, mean age 53.6 +/- 10.3 years, 264 men and 260 women, were studied. All participants underwent a thorough clinical and laboratory evaluation, including an oral glucose tolerance test and insulin measurements. Echocardiography, carotid ultrasonography, and pulse wave analysis were also performed for the detection of target organ damage. NCEP-ATP III and ADA criteria were used for the diagnosis of MetS and prediabetes.
RESULTS
The prevalence of MetS and prediabetes was 38.7 and 25.4 %, respectively. Overall, 129 individuals (24.6 %) had MetS without prediabetes (group M) and another 59 (11.3 %) prediabetes without MetS (group P). Group P had decreased albumin excretion (p = 0.033) and more thickened common carotid intima-media in comparison to group M (p = 0.032). Furthermore, group M was associated with higher C-reactive protein levels. Multiple logistic regression analysis revealed that advanced age (p < 0.0001, OR 1.11, 95 % CI 1.06 - 1.16), low insulin secretion (p < 0.0001, OR 0.05, 95 % CI 0.02 - 0.18 for insulinogenic index), and increased insulin resistance (p = 0.0003, OR 3.22, 95 % CI 1.71 - 6.07 for HOMA-IR) were associated with group P.
CONCLUSIONS
Our data demonstrate that MetS and prediabetes have an overlapping pattern. MetS appears to have a more pronounced effect on early renal dysfunction and increased inflammatory activation, while prediabetes tends to be associated with early carotid structural changes. These findings may be due to a different pathophysiologic substrate of these clinical phenotypes in terms of insulin resistance and secretion, as well as to the varying prevalence of cardiovascular risk factors.
Topics: Adult; Aged; Cohort Studies; Diagnosis, Differential; Female; Humans; Male; Medical History Taking; Metabolic Syndrome; Middle Aged; Obesity; Overweight; Prediabetic State
PubMed: 16915541
DOI: 10.1055/s-2006-924319 -
Journal of Hypertension Jan 2021
Topics: Blood Glucose; Cardiovascular Diseases; Cardiovascular System; Humans; Prediabetic State; Risk Factors
PubMed: 33273361
DOI: 10.1097/HJH.0000000000002644 -
Diabetes & Metabolic Syndrome 2016Cardiac autonomic dysfunction (CAD) is associated with both prediabetes and metabolic syndrome (MS). Heart rate variability (HRV) and heart rate turbulence (HRT) are...
AIMS
Cardiac autonomic dysfunction (CAD) is associated with both prediabetes and metabolic syndrome (MS). Heart rate variability (HRV) and heart rate turbulence (HRT) are reliable 24-h Holter-ECG findings of cardiac autonomic function. This study aimed to investigate the relation between MS and its components and CAD using HRV and HRT.
MATERIALS AND METHODS
The study included 80 non-diabetic patients with MS and 70 control subjects. All study population and the patients with MS were further analyzed for each diagnostic component of MS to investigate which criteria impaired HRV and HRT.
RESULTS
HRV and HRT parameters were disturbed in patients in the MS group. While impairment in HRV and HRT was significantly related to the presence of the fasting plasma glucose (FPG) criterion, there were no differences between groups in terms of the other 4 MS criteria. Moreover, FPG level was significantly correlated with SDNN (r=-0.352, p<0.001), SDNN index (r=-0.423, p<0.001), SDANN (r=-0.301, p<0.001), RMSSD (r=-0.237, p<0.001), pNN50 (r=-0.237, p<0.001), turbulence onset (TO) (r=0.365, p<0.001) and turbulence slope (TS) (r=-0.365, p<0.001). Among the MS diagnostic criteria, only FPG level was an independent determinant of all HRV and HRT parameters.
CONCLUSIONS
This study confirms the relation between MS and CAD. Increased FPG alone appears to be responsible for the mentioned findings among the 5 diagnostic criteria. Accordingly, CAD may be the result of prediabetes, not MS in patients with MS.
Topics: Adult; Aged; Autonomic Nervous System; Blood Glucose; Case-Control Studies; Electrocardiography; Female; Heart; Heart Diseases; Heart Rate; Humans; Male; Metabolic Syndrome; Middle Aged; Prediabetic State
PubMed: 26610403
DOI: 10.1016/j.dsx.2015.09.001 -
Journal of Diabetes and Its... 2014As the global epidemic of type 2 diabetes continues to rise, the time has come to revisit our approach to pre-diabetes. Recently, much ado has been made about screening,... (Review)
Review
As the global epidemic of type 2 diabetes continues to rise, the time has come to revisit our approach to pre-diabetes. Recently, much ado has been made about screening, diagnosis, pathophysiology and clinical interventions in pre-diabetes, and all for good reason as the key to reversing the diabetes epidemic likely lies therein. The somewhat controversial term "pre-diabetes" represents collective dysglycemic states intermediate between normal glucose regulation (NGR) and diabetes. Not all people with pre-diabetes will develop diabetes, but the majority will. In fact, up to 70% of those with pre-diabetes may acquire the disease over their lifetime. Furthermore, even when overt diabetes is delayed or prevented, both micro- and macrovascular disease appears more prevalent in those with pre-diabetes compared to their normoglycemic peers. Hence, there is growing consensus that NGR should be the goal for people with pre-diabetes. Nevertheless, there is much to consider in that pursuit. Herein, we provide an update on the global burden of pre-diabetes, its underlying pathophysiology and discuss clinical considerations in these individuals at high risk of developing diabetes.
Topics: Diabetes Mellitus, Type 2; Humans; Mass Screening; Prediabetic State; Risk Factors
PubMed: 24342268
DOI: 10.1016/j.jdiacomp.2013.10.008