Prediabetes as a Therapeutic Target

BACKGROUND: The term “prediabetes” is used to describe a condition that involves impaired glucose tolerance (IGT) or impaired fasting glucose (IFG). IGT is defined by a 2-h oral glucose tolerance test plasma glucose concentration >140 mg/dL (7.8 mmol/L) but <200 mg/dL (11.1 mmol/L), and IFG is defined by a fasting plasma glucose concentration ≥100 mg/dL (5.6 mmol/L), but <126 mg/dL (7.0 mmol/L). Studies have shown that people with prediabetes tend to develop type 2 diabetes within 10 years and are at increased risk for cardiovascular disease and death even before the development of diabetes. CONTENT: In this minireview we discusses the epidemiology, pathophysiology, and clinical implications of prediabetes. The rationale for therapeutic intervention in people with prediabetes, the goals of intervention, and the specific tools for intervention are presented. Emphasis is placed on data from randomized controlled clinical trials, whenever such data are available. SUMMARY: Approximately 57 million Americans have prediabetes and are consequently at risk for cardiometabolic complications. Lifestyle modifications (dietary restriction and exercise) and certain medications can prevent the development of diabetes in persons with prediabetes. Lifestyle intervention also has been demonstrated to decrease cardiovascular disease risk markers, although data on clinical events are lacking.