Prediabetes as atherapeutic challenge in internal medicine

Abstract

The term prediabetes describes afasting blood glucose level that is elevated but not yet in the diabetic range, ablood glucose level that is elevated after 120 min in astandard 75‑g oral glucose tolerance test, or both. The American Diabetes Association definition also includes glycated hemoglobinA (HbA1c). The incidence of prediabetes is rapidly increasing. Progression from normal glucose tolerance to diabetes is acontinuous process. Insulin resistance and insulin secretory dysfunction, the simultaneous presence of which characterizes manifest diabetes, are already present in the prediabetic stage. Prediabetes is associated with an increased risk of diabetes; however, by no means all people with prediabetes go on to develop diabetes. Nevertheless, the identification of an increased risk of diabetes is still relevant insofar as it requires the adoption of diabetes prevention measures. Structured lifestyle intervention has been shown to be the most effective strategy for treating prediabetes. To increase its efficiency, it should, as far as possible, be made exclusively available to those people on whom it is most likely to confer abenefit. This would make it necessary to stratify people with prediabetes according to their risk profile. In apopulation of people at increased risk of diabetes (Tübingen Diabetes Family Study), acluster analysis was performed, resulting in six clusters/subgroups. Within these, three high-risk subgroups were identified: Two of these risk groupsshow predominant insulin secretory dysfunction or predominant insulin resistance and high diabetes and cardiovascular risk. The third group shows ahigh risk of nephropathy and high mortality, but acomparatively lower diabetes risk. In general, prediabetes cannot yet be treated in atargeted pathophysiologically oriented manner. The new classification of prediabetes-based on pathophysiology-is now opening up new avenues for diabetes prevention. Current and future studies should confirm the assumption that the effectiveness of established, or not yet established, preventive measures depends on the respective subgroup.