Vascular complications in prediabetes and type 2 diabetes: a continuous process arising from a common pathology

Abstract

The term, “prediabetes”, describes a state of hyperglycaemia that is intermediate between true normoglycaemia and the diagnostic cut-offs for indices of glycaemia that are used to diagnose type 2 diabetes. The presence of prediabetes markedly increases the risk of developing type 2 diabetes. Numerous randomized, controlled evaluations of various agents have demonstrated significant prevention or delay of the onset of type 2 diabetes in subjects with prediabetes. Intensive lifestyle interventions and metformin have been studied most widely, with the lifestyle intervention being more effective in the majority of subjects. The application of therapeutic interventions at the time of prediabetes to preserve long-term outcomes has been controversial, however, due to a lack of evidence relating to the pathogenic effects of prediabetes and the effectiveness of interventions to produce a long-term clinical benefit. Recent studies have confirmed that prediabetes, however defined, is associated with a significantly increased risk of macrovascular and microvascular complications essentially identical to those of diabetes, and also with subclinical derangements of the function of microvasculature and neurons that likely signify increased risk of compilations in future. Normoglycaemia, prediabetes and type 2 diabetes appear to be part of a continuum of increased risk of adverse outcomes. Long-term (25–30 years) post-trial follow up of two major diabetes prevention trials have shown that short-term interventions to prevent diabetes lead to long-term reductions in the risk of complications. These findings support the concept of therapeutic intervention to preserve long-term health in people with prediabetes before type 2 diabetes becomes established.

Keywords:

• Prediabetes
• hyperglycaemia
• type 2 diabetes
• diabetic complications
• antidiabetic therapy

Transparency

Declaration of funding

Merck KGaA, Darmstadt, Germany funded Fast Track review, colour printed figures, and open access publication for this article. No payments were made for authorship of this article and no other funding applied.

Declaration of financial/other relationships

UH is an employee of Merck Healthcare KGaA, Darmstadt, Germany. MG has provided paid editorial consultancy services to Merck Healthcare KGaA, Darmstadt, Germany. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgements

None.