Prediabetes is a state of abnormal glucose homeostasis characterized by the presence of impaired fasting glucose, impaired glucose tolerance, or both. Individuals with prediabetes are at increased risk for type 2 diabetes, compared with individuals with normal glucose values (normal fasting plasma glucose, < 100 mg/dL [5.6 mmol/L]). The increased risk for cardiovascular disease in prediabetes is multifactorial, with etiologies including insulin resistance, hyperglycemia, dyslipidemia, hypertension, systemic inflammation, and oxidative stress. The preferred treatment is intensive lifestyle management and aggressive pharmacologic therapies directed toward individual coronary heart disease risk factors. The use of antihyperglycemic agents in this setting is a topic of intense debate. This review discusses the pathophysiology of prediabetes and its clinical implications, highlighting the importance of early identification and intervention.

Funding for this study was sponsored by Novartis, East Hanover, New Jersey. Bloudek and Kish are employees of Xcenda, a consulting company contracted by Novartis to conduct this analysis. Roy, Globe, and Kuriakose are employees of Novartis. Siegel is on the advisory boards and speaker's bureau of Celgene, Onyx/Amgen, Millennium/Takeda, and Novartis and is on the advisory boards of Merck. Jagannath is a consultant to Sanofi, Bristol-Meyers Squibb, and Celgene. Orloski is a contractor to Xcenda and provided medical writing support, which was funded by Novartis. Study design and concept were contributed by Bloudek, Roy, and Kish, assisted by Globe. Bloukek took the lead in data collection, along with Kish, and data interpretation was performed by Siegal, Jagannath, Globe, and Kuriakose. The manuscript was written primarily by Orloski, along with Roy and Kish, and revised by Roy, along with Siegal, Jagannath, Globe, Orloski, and Kuriakose.

Background Droxidopa is approved for adult patients with symptomatic neurogenic orthostatic hypotension (nOH); there is limited information regarding effects on symptoms, outcomes, and quality of life (QOL) beyond two weeks of treatment. Objective Examine the real‐world experience of patients taking droxidopa after six months of treatment. Methods This non‐interventional, US‐based, prospective cohort study utilized a pharmacy hub, identifying patients who recently started droxidopa for nOH treatment. Questionnaires for fall frequency and other patient‐reported outcomes (PROs) were completed at baseline and one, three, and six months following droxidopa initiation. Results 179 enrolled patients completed baseline surveys. Droxidopa continuation rates were high at months one, three, and six (87%, 79%, and 75%, respectively). From baseline to month one, there was significant reduction in the proportion of patients reporting falling at least once (54.1% vs. 43.0%; P = 0.0039), with similar observations at month three (52.9% vs. 44.5%; P = 0.0588) and month six (51.4% vs. 40.0%; P = 0.0339). Significant improvements from baseline to month one were observed and maintained at months three and six for most PROs, including the Orthostatic Hypotension Symptom Assessment Item 1, Short Falls Efficacy Scale‐International, Sheehan Disability Scale, Physical Component of the 8‐item Short‐Form Health Survey, and Patient Health Questionnaire‐9. Conclusions In this non‐interventional prospective study, fewer nOH patients reported falling after one, three, and six months of droxidopa treatment. Further, improvements reported in nOH symptoms, physical function, and QOL measures were maintained for six months following treatment initiation. Results from randomized clinical trials are required to validate the findings.

Prophylactic quadrivalent HPV 6/11/16/18 vaccination of young Asia-Pacific women demonstrated high efficacy, safety, and tolerability. Together with an observed low baseline HPV positivity rate, the Asia-pacific population is potentially an important cohort to benefit from vaccination.

As a consequence of the aging population and the increasing prevalence rates for conditions such as type 2 diabetes and chronic kidney disease (CKD), management of hypertension will be focusing more and more on the high-risk patient. Clinical practice guidelines for managing hypertension in the United States recommend a target blood pressure (BP) o130/80 mm Hg in patients with diabetes or CKD, notably lower than the 140/90-mm Hg threshold for the general hypertensive population. However, the optimal timeframe from initiation of antihypertensive therapy to attaining these levels of BP control and influencing cardiovascular outcomes is not as well defined. Overall, a series of landmark BP intervention trials in patients with hypertension and additional cardiovascular risk factors collectively support that achieving prompt BP control, ideally within 1-3 months, translates into improved cardiovascular outcomes. Although the consistency of the findings is encouraging, the strength of this conclusion is limited by the available data, which were derived from studies not designed to determine the definition or benefits of early BP reduction. In several of these studies, using a treatment approach with initial monotherapy or combination therapy has clearly demonstrated pronounced BP lowering and high BP control rates within an intensive timeframe of 3-6 months of therapy. Although these studies were not conducted exclusively in high-risk patients, subgroup analyses have demonstrated that the observed outcomes in the overall study populations apply to the diabetic and CKD subsets.