Pharmacotherapeutic options for prediabetes

ABSTRACT

Introduction

‘Prediabetes’ is a condition of elevated glucose not attaining the established criteria for a diagnosis of diabetes. The United States Diabetes Prevention Program (DPP) began in 1996 and was the iconic study of prediabetes. In that study, after 3 years, the risk of reaching the numerical criteria of diabetes was reduced by 58% by intensive emphasis on diet and exercise whereas treatment with metformin achieved a lesser reduction of 31%. The DPP was widely heralded as suggesting that lifestyle change was superior to pharmacologic therapy in the prediabetes population. This conclusion may be overreaching in terms of the long-term results of that study.

Areas covered

The author reviews the subsequent pharmacologic efforts to prevent diabetes in this population. He reviews the existing literature for pharmacologic treatment of prediabetes using Pubmed.gov using the keywords of prediabetes, impaired fasting glucose and impaired glucose tolerance.

Expert opinion

Prediabetes is primarily related to being overweight. Obesity has health consequences going beyond glucose elevation. The approach to prediabetes should be primarily by pursuing weight loss with therapeutic agents such as GLP-1 receptor agonists and SGLT2 inhibitors.

KEYWORDS:

• Prediabetes
• impaired fasting glucose
• impaired glucose tolerance
• obesity
• diabetes prevention
• weight loss

Article highlights

- Diabetes is a condition caused by glucose levels rising above the ‘normal’ range.

- Diabetes is one of the foremost causes of adult blindness, kidney failure, heart disease, strokes, and peripheral neuropathy.

- Prediabetes as a state of elevated glucose levels with fasting plasma glucose (FPG) of 6.1-6.9 mmol/L (110 to 125 mg/dL).

- The condition of prediabetes is eminently treatable. Yet, there is no current consensus by the medical community to screen for prediabetes and to proceed to treat.

- In the future, there must be an effort to treat prediabetes and more so overweight in a manner similar to the successful approach to hypertension, and that effort must be endorsed and supported by the medical insurance system.

This box summarizes key points contained in the article.

Declaration of interest

M Rendell is the Executive Director of the Association of Diabetes Investigators and the Medical Director of the Rose Salter Medical Research Foundation. He has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript is funded by The Association of Diabetes Investigators and the Rose Salter Medical Research Foundation.