Should Prediabetes Be Classified as a Treatable Disease?

TL;DR

Prediabetes affects millions globally and can progress to diabetes, but it can be managed with lifestyle changes and medication, suggesting it should be classified as a treatable disease.

Contribution

The paper argues for reclassifying prediabetes as a treatable disease due to its high prevalence, serious complications, and effective interventions.

Findings

Prediabetes is linked to increased risks of type 2 diabetes and cardiovascular disease.

Lifestyle changes and metformin therapy can effectively prevent progression to type 2 diabetes.

Classifying prediabetes as a disease could improve early intervention and reduce global health burdens.

Abstract

Prediabetes is a serious and major global problem afflicting approximately 21% of the world’s population. It is the intermediate stage between normal glucose levels and type 2 diabetes mellitus (T2DM). Prediabetes is associated with major complications including the development of T2DM and increased cardiovascular disease (CVD). It can be easily diagnosed with an inexpensive plasma glucose level and/or a hemoglobin A1c (HbA1c) measurement. The mainstay of treatment is intensive lifestyle (ILS) intervention, including reduction in calories, especially saturated fats, refined carbohydrates, etc., coupled with regular physical activity of 150 min per week since ILS changes, with at least a 5% weight loss, have been shown to reduce progression to T2DM in multiple studies globally. Also, metformin therapy has been shown to prevent the progression to T2DM. In conclusion, serious consideration by guideline committees to classify prediabetes as a disease is highly recommended based on its global burden, easy and cost-effective diagnosis, association with serious conditions of diabetes and CVD, and effective ILS intervention. Therapy targeting those at an especially high risk for T2DM, such as persons with impaired glucose tolerance (IGT), impaired fasting glucose (IFG) with values ≥ 110 mg/dL (6.1 mmol/L), and/or HbA1c ≥ 6.0% (42 mmol/mol) coupled with overweightness or obesity.

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