Abstract
Type 2 diabetes mellitus (T2DM) is increasing in prevalence worldwide, and those non-diagnosed or misdiagnosed comprise a significant group compared to those diagnosed. Accumulated scientific evidence indicate that the current diagnostic markers (fasting glycemia, 2h glycemia after an oral glucose load and HbA1c) are indeed late diagnostic criteria when considering the incidence of diabetes-related complications and comorbidities, which are also at high risk in some groups among normoglycemic individuals. Additionally, the earlier identification of future risk of diabetes is desirable since it would allow better adherence to preventive actions such as lifestyle intervention, ultimately avoiding complications and minimizing the economic impact/burden on health care expenses. Insulin resistance and hyperhormonemia (insulin, amylin, glucagon) are non-disputable hallmarks of T2DM, which already takes place among these normoglycemic, otherwise health subjects, characterizing a state of subclinical diabetes. Insulin resistance and hyperinsulinemia can be computed from fasting plasma insulin as an independent variable in normoglycemia. An overview of the current diagnostic criteria, disease onset, complications, comorbidities and perspectives on lifestyle interventions are presented. A proposal for early detection of subclinical diabetes from routine evaluation of fasting plasma insulin, which is affordable and robust and thus applicable for the general population, is further suggested.
Highlights
DIABETES COMPLICATIONS IN DIABETIC INDIVIDUALS5 “Those with cardiovascular disease not identified with diabetes are undiagnosed”. (Kraft 2008)
Type 2 diabetes mellitus (T2DM) is increasing in prevalence worldwide, and those non-diagnosed or misdiagnosed comprise a significant group compared to those diagnosed
Several studies and organizations have shown an unprecedented increase in the prevalence of diabetes worldwide (NCD-RisC 2016), including type 1 DM (T1DM) (Harjutsalo et al 2008, Patterson et al 2009, Dabelea et al 2014, Forga Llenas et al 2015, Lamb et al 2015), and the estimated number of adults with diabetes has soared to over 380 million (> 8 % world adult population, > 12% in USA) (Menke et al 2015), with a mean estimation of over 37 % with pre-diabetes and over 45 % undiagnosed according to current diagnostic criteria (Schmidt et al 2011, Federation 2015, Mechanick 2015, Menke 2015)
Summary
5 “Those with cardiovascular disease not identified with diabetes are undiagnosed”. (Kraft 2008). The Diabetes Control and Complication Trial (DCCT) conducted with 1,441 T1DM individuals with a mean follow-up of 6.5 years showed that the intervention arm under intensive pharmaceutical therapy, with a tight glycemic control close to normal reference values, presented reduction of long-term complications such as retinopathy, nephropathy and neuropathy (DCCT 1993). The rate of progression of retinopathy fell as HbA1c decreased These benefits observed in the DCCT showed long-term, sustained effects as observed by the lower risk of microvascular (DCCT-EDIC 2000), cardiovascular outcomes and myocardial infarction as seen in the Epidemiology of Diabetes Interventions and Complications study (EDIC), a mean follow-up of 17 years of the DCCT (Nathan et al 2005). The trend in increasing of the prevalence of any retinopathy has been seen as a HbA1c dependent variable within the normal reference range in cross-sectional epidemiological studies with the Pima Indians, an Egyptian study, and the third National Health and Nutrition Examination Survey (NHANES) (WHO 2015, Colagiuri et al 2011)
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