Addressing the Continuum of Dysglycaemia and Vascular Complications in Prediabetes and Type 2 Diabetes: Need for Early and Intensive Treatment

Abstract

The onset of type 2 diabetes increases the risk of vascular complications and death. We know now that that this risk begins long before the diabetes diagnosis. Prediabetes and type 2 diabetes are not separate entities in practice and exist within a continuum of dysglycaemia and vascular risk that increases in severity over time. This excess risk requires early intervention with lifestyle therapy supported with pharmacologic antidiabetic therapy, intensified promptly where necessary throughout the duration of the diabetes continuum. Metformin is an evidence-based treatment for preventing prediabetes and improves cardiovascular outcomes in people with type 2 diabetes from diagnosis onwards. Newer agents (SGLT2 inhibitors and GLP-1 agonists) are appropriate for people presenting with type 2 diabetes and significant cardiovascular comorbidity. Additional therapies should be used without delay to achieve patients’ individualised HbA1c goals and to minimise cardiovascular risk.

Unraveling shared risk factors for diabetic foot ulcer: a comprehensive Mendelian randomization analysis

“…A clinical control study observed that about 19.4% of patients with impaired glucose tolerance reported peripheral neuropathic symptoms 36. While an earlier small-scale survey did not find a significant difference in DPN incidence between glucose-impaired individuals and the general population,37 recent researchers generally agree that DPN occurrence is a continuous process along with impaired glucose and diabetes diagnosis 38. Therefore, early intensified glucose intervention is crucial for preventing diabetic microvascular complications.…”

“…36 While an earlier small-scale survey did not find a significant difference in DPN incidence between glucose-impaired individuals and the general population, 37 recent researchers generally agree that DPN occurrence is a continuous process along with impaired glucose and diabetes diagnosis. 38 Therefore, early intensified glucose intervention is crucial for preventing diabetic microvascular complications. This study supports this view, suggesting that avoiding diabetic complications may require stricter blood glucose control standards than current diabetes diagnosis.…”

Prevalence of haemoglobin A1c based dysglycaemia among adult community dwellers in selected states in Nigeria: a descriptive cross-sectional study

“…Previous studies suggest that the prevalence of pre-diabetes in Nigeria ranged between 2.0% and 37.2%, while that of diabetes varied from 5% to 10%. 8 For a conservative sample size, we assumed the upper limits of the prevalence. Therefore, we assumed that the prevalence of the glycaemic disorder is 37.2%, at a 95% confidence level, 2.5% error margin, and a design effect of 1.5.…”

“…Pre-diabetes (IGT and IFG) indicate an already heightened risk of cardiovascular disease ( 3 , 6 , 7 ), and their recognition compels urgent interventions that can lead to the prevention of type 2 diabetes and its complications ( 8 ). Fasting blood glucose and 2-h oral glucose tolerance test (OGTT) are the traditional methods of screening and diagnosis of diabetes.…”