Abstract
Even though the new thresholds for defining prediabetes have been around for more than ten years, there is still controversy surrounding the precise characterization of this intermediate glucose metabolism status. The risk of developing diabetes and macro and microvascular disease linked to prediabetes is well known. Still, the prediabetic population is far from being homogenous, and phenotyping it into less heterogeneous groups might prove useful for long-term risk assessment, follow-up, and primary prevention. Unfortunately, the current definition of prediabetes is quite rigid and disregards the underlying pathophysiologic mechanisms and their potential metabolic progression towards overt disease. In addition, prediabetes is commonly associated with a cluster of risk factors that worsen the prognosis. These risk factors all revolve around a common denominator: inflammation. This review focuses on identifying the population that needs to be screened for prediabetes and the already declared prediabetic patients who are at a higher risk of cardiovascular disease and require closer monitoring.
Highlights
Even though the term prediabetes has been around for more than ten years, the medical community is still divided into believers and non-believers
The current review focuses on what factors carry a worse prognosis when associated with prediabetes and whether a sub-phenotyping strategy would benefit high-risk patients in terms of early intervention and prevention of cardiovascular disease development
The diagnosis of prediabetes is established by fasting plasma glucose (FPG), 2 h plasma glucose (PG) during 75 g oral glucose tolerance test (OGTT), or the level of glycated hemoglobin (HbA1c) [6,7]
Summary
Even though the term prediabetes has been around for more than ten years, the medical community is still divided into believers and non-believers. Other organizations including the WHO, the UK National Institute for Health and Care Excellence, the European Association for the Study of Diabetes (EASD), and the International Diabetes Federation (IDF) are more cautious in using the term prediabetes as it is defined by the ADA, especially when using the HbA1c criteria. It is worth mentioning that the risk of developing diabetes does depend on the intermediate glycemia status alone but is dependent on age, sex, body mass index, and genetic, environmental, or ethnic characteristics, leading to great variability in the measurement of progression from prediabetes to diabetes, depending on the inclusion criteria of the studied population. The current review focuses on what factors carry a worse prognosis when associated with prediabetes and whether a sub-phenotyping strategy would benefit high-risk patients in terms of early intervention and prevention of cardiovascular disease development
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