Biomedicines | Free Full-Text | Prediabetes and Cardiometabolic Risk: The Need for Improved Diagnostic Strategies and Treatment to Prevent Diabetes and Cardiovascular Disease
2. Cardiovascular Risk, Morbidity, and Mortality in Prediabetes
3. An Adequate or Insufficient Diagnostic Criterion?
3.1. Controversy in the Established Cut-Off Values
3.2. Proposed New Cut-Off Points in the OGTT for the Diagnosis of Prediabetes
3.3. Other Approaches to Define Patients at Risk
One of the principal reasons to diagnose prediabetes is to identify subjects at risk. However, there are other definitions or scores to evaluate subjects at risk for T2DM and CVD. The MetS, a collection of risk factors that increases the risk of developing heart disease, stroke, and diabetes, and risk scores such as the Finnish Diabetes Risk Score (FINDRISC), the ADA risk score, or the National Institute for Health and Care Excellence (NICE) risk score, may be useful tools to identify subjects at increased risk for diabetes and CVD.
5. Established Phenotypes Related to The Development of T2DM
6. What Is the Importance of Intervening in Patients with Prediabetes?
Cardiometabolic risk is increased in prediabetic states. Refining the definition of prediabetes to include other measures such as components of the MetS might better define individual risk and guide treatment. A first screening with fasting glycemia is reasonable to detect IFG, but a sequential evaluation using the curve of the OGTT might be optimal, especially in subjects at high risk. Individualizing the diagnosis of prediabetes and considering the pathophysiology and clinical characteristics might help to define the risk of both T2DM and CVD and improve the targeting of intervention strategies.
Interventions for prediabetic patients have shown to be of benefit in the short-term in reducing the incidence of T2DM, and, in the long-term, have shown a similar benefit, especially in patients who return to normal glucose regulation. The reduction in the risk of cardiovascular complications is still controversial after intervention in prediabetic patients. However, this does not diminish the importance of lifestyle modification, which should be recommended for prediabetic patients given its other proven benefits.
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