Clinical aspects of pre-diabetic patients

Non-diabetic hyperglycemia that does not satisfy the diagnostic criteria for diabetes mellitus (DM) is generally known as pre diabetes (pre DM). All patients with type ۲ DM (T۲DM) pass through this pre diabetic state before escalating into full-blown diabetes. Because it is generally agreed that the risks of T۲DM and cardiovascular disease are significantly increased in pre DM subjects, life style modifications have been recommended as a method to control pre DMDIAGNOSTIC CRITERIA OF PREDIABETES: Similar to DM, fasting plasma glucose (FPG) and oral glucose tolerance tests are both used independently as defining criteria for pre DM. Recently, hemoglobin A۱c (HbA۱c) has also been used in the diagnosis of pre DM .According to the recent clinical practice recommendations published in ۲۰۲۳ by the American Diabetes Association (ADA), pre DM is defined as: ۱) impaired fasting glucose (IFG) with fasting plasma glucose levels of ۱۰۰ to ۱۲۵ mg/dL (۵.۶ to ۶.۹ mmol/L), ۲) impaired glucose tolerance (IGT) with plasma glucose levels of ۱۴۰ to ۱۹۹ mg/dL (۷.۸ to ۱۱.۰ mmol/L) ۲-hour postprandial, or ۳) an HbA۱c of ۵.۷ to ۶.۴% . When using oral glucose tolerance testing as a screen for diabetes, adequate carbohydrate intake (at least ۱۵۰ g/day) should be assured for ۳ days prior to testing . Testing for prediabetes and/or type ۲ diabetes in asymptomatic people should be considered in adults of any age with overweight or obesity (BMI ≥۲۵ kg/m۲ or ≥۲۳ kg/m۲ in Asian Americans) who have one or more risk factors If tests are normal, repeat screening recommended at a minimum of ۳-year intervals is reasonable, sooner with symptoms or change in risk . In an ۱۱-year follow-up study on Mauritius adults with IGT, ۴۶% progressed into overt DM, ۲۸% retained their condition, ۴% changed to IFG, and ۲۴% showed normalized glucose tolerance . For patients with IFG, ۳۸% developed overt DM, ۷% experienced no change, ۱۷% progressed to IGT, and ۳۸% developed normalized glucose tolerance. The occurrence of cardiovascular disease and associated mortality in pre DM subjects compared with normal glucose tolerance are known to be significantly elevated( over ۵۰%) and this risk was greater in young adults. However, in each study, there were differences in the risks of developing cardiovascular disease between IFG and IGT, and when confounding variables were compensated for, the risk of developing cardiovascular disease was lowered.CONCLUSIONS: Pre DM is a risk factor for both T۲DM and cardiovascular disease. However, the clinical course of this entity is variable and there are inadequacies in defining it as a single disease. The prevalence of pre DM is higher than that of T۲DM, and through proper management, recovery of normal glucose tolerance is possible. Additionally, because complications can be prevented, the clinical approach is more aggressive. Individual management of pre DM is required given the observed significant pathophysiological heterogeneity between the subtypes. Through future research, the pathophysiology of pre DM and early stage T۲DM is expected to become much more widely understood.