Current and emerging pharmacotherapy for prediabetes: are we moving forward?

Mangan, Aisling; Docherty, Neil G.; Roux, Carel W. le; Al‐Najim, Werd

doi:10.1080/14656566.2018.1517155

Cited by 6 publications

(6 citation statements)

References 57 publications

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“…Considering the high prevalence of prediabetes, and the robust and significant association between prediabetes and health risk shown in our study, successful intervention in this large population could have a major effect on public health. Although prediabetes is commonly asymptomatic, it represents a window of opportunity to prevent progression to type 2 diabetes and its complications 33. Community mobilisation and lifestyle intervention for prediabetes can lead to a significant reduction in the incidence of diabetes 2934.…”

Section: Discussionmentioning

confidence: 99%

“…Although prediabetes is commonly asymptomatic, it represents a window of opportunity to prevent progression to type 2 diabetes and its complications. 33 Community mobilisation and lifestyle intervention for prediabetes can lead to a significant reduction in the incidence of diabetes. 29 34 Follow-up studies from the Diabetes Prevention Programme have shown that lifestyle intervention can be cost effective in preventing diabetes, and that treatment with metformin can even be cost saving.…”

Section: Discussionmentioning

confidence: 99%

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Association between prediabetes and risk of all cause mortality and cardiovascular disease: updated meta-analysis

Cai

Zhang

et al. 2020

BMJ

434

311

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Objective To evaluate the associations between prediabetes and the risk of all cause mortality and incident cardiovascular disease in the general population and in patients with a history of atherosclerotic cardiovascular disease. Design Updated meta-analysis. Data sources Electronic databases (PubMed, Embase, and Google Scholar) up to 25 April 2020. Review methods Prospective cohort studies or post hoc analysis of clinical trials were included for analysis if they reported adjusted relative risks, odds ratios, or hazard ratios of all cause mortality or cardiovascular disease for prediabetes compared with normoglycaemia. Data were extracted independently by two investigators. Random effects models were used to calculate the relative risks and 95% confidence intervals. The primary outcomes were all cause mortality and composite cardiovascular disease. The secondary outcomes were the risk of coronary heart disease and stroke. Results A total of 129 studies were included, involving 10 069 955 individuals for analysis. In the general population, prediabetes was associated with an increased risk of all cause mortality (relative risk 1.13, 95% confidence interval 1.10 to 1.17), composite cardiovascular disease (1.15, 1.11 to 1.18), coronary heart disease (1.16, 1.11 to 1.21), and stroke (1.14, 1.08 to 1.20) in a median follow-up time of 9.8 years. Compared with normoglycaemia, the absolute risk difference in prediabetes for all cause mortality, composite cardiovascular disease, coronary heart disease, and stroke was 7.36 (95% confidence interval 9.59 to 12.51), 8.75 (6.41 to 10.49), 6.59 (4.53 to 8.65), and 3.68 (2.10 to 5.26) per 10 000 person years, respectively. Impaired glucose tolerance carried a higher risk of all cause mortality, coronary heart disease, and stroke than impaired fasting glucose. In patients with atherosclerotic cardiovascular disease, prediabetes was associated with an increased risk of all cause mortality (relative risk 1.36, 95% confidence interval 1.21 to 1.54), composite cardiovascular disease (1.37, 1.23 to 1.53), and coronary heart disease (1.15, 1.02 to 1.29) in a median follow-up time of 3.2 years, but no difference was seen for the risk of stroke (1.05, 0.81 to 1.36). Compared with normoglycaemia, in patients with atherosclerotic cardiovascular disease, the absolute risk difference in prediabetes for all cause mortality, composite cardiovascular disease, coronary heart disease, and stroke was 66.19 (95% confidence interval 38.60 to 99.25), 189.77 (117.97 to 271.84), 40.62 (5.42 to 78.53), and 8.54 (32.43 to 61.45) per 10 000 person years, respectively. No significant heterogeneity was found for the risk of all outcomes seen for the different definitions of prediabetes in patients with atherosclerotic cardiovascular disease (all P>0.10). Conclusions Results indicated that prediabetes was associated with an increased risk of all cause mortality and cardiovascular disease in the general population and in patients with atherosclerotic cardiovascular disease. Screening and appropriate management of prediabetes might contribute to primary and secondary prevention of cardiovascular disease.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Association between prediabetes and risk of all cause mortality and cardiovascular disease: updated meta-analysis

Cai

Zhang

et al. 2020

BMJ

434

311

View full text Add to dashboard Cite

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“…Prediabetes is a toxic state in which both micro-and macrovascular complications of diabetes can manifest [6]. The prompt diagnosis and proper management of prediabetes are necessary to prevent progression to diabetes mellitus and to prevent microvascular and macrovascular complications that manifest early in the prediabetic state [7].…”

Section: Introductionmentioning

confidence: 99%

Correlation between prediabetes and coronary artery disease severity in patients undergoing elective coronary angiography

et al. 2019

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Background: Diabetes is a chronic disease that is responsible for a high rate of morbidity and mortality which can be attributed to atherosclerosis and cardiovascular disease. Diabetes is heralded by prediabetes which not only indicates a higher risk of developing diabetes but also increases the burden of cardiovascular disease. The objective was to observe the effect of prediabetes on the severity of coronary artery disease in patients undergoing elective coronary angiography. Seven hundred and thirty-one patients were admitted for elective coronary angiography and/or PCI starting from September 2017 to August 2018. Patients were divided into group A (normoglycemic group, N = 228), group B (prediabetes group, N = 177), and group C (diabetic group, N = 326). Coronary artery disease (CAD) severity including number of vessels affected and atherosclerotic burden by Gensini score were compared among different groups. Results: The number of vessels affected as well as left main (LM) disease was higher in the prediabetes group when compared to the normoglycemic group (P,=0.001, P = 0.009, respectively) and was comparable to the diabetes group (P = 0.4, P = 0.6, respectively). Prediabetes showed a Gensini score higher than the normoglycemic group (P = 0.0001) with no significant difference when compared to the diabetic group (P = 0.9). Conclusion: Prediabetes is associated with high atherosclerotic burden and coronary artery disease complexity that is similar to diabetic than normoglycemic individuals.

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“…The National Institute for Health and Care Excellence (NICE) guidelines suggest that individuals with IGT or IFG should firstly receive lifestyle intervention by increasing physical activity, reducing body weight, and health education. [4] Specifically, people with prediabetes should exercise for no less than 150 min/week and cut down 5%-10% of body weight within a year. [18] Similar suggestions are given by other guidelines from the American Diabetes Association (ADA) that patients should perform a high-intensity exercise at 200-300 min/week and eat a very low-calorie diet (500-750 kcal/day) for 3 months to achieve a weight loss of >5%.…”

Section: Lifestyle Interventionmentioning

confidence: 99%

“…[3] Due to the ambiguity of diagnostic criteria and thresholds, asymptomatic prediabetes is likely to be ignored and evolves into T2D. [4] JOURNAL OF TRANSLATIONAL INTERNAL MEDICINE / JUL-SEP 2020 / VOL 8 |ISSUE 3…”

Section: Introductionmentioning

confidence: 99%

A P4 medicine perspective of gut microbiota and prediabetes: Systems analysis and personalized intervention

Huang

Fang

2020

Journal of Translational Internal Medicine

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Type 2 diabetes (T2D) accounts for approximately 90% of diabetes worldwide and has become a global public health problem. Generally, individuals go to hospitals and get healthcare only when they have obvious T2D symptoms. While the underlying cause and mechanism of the disease are usually not well understood, treatment is for the symptoms, but not for the disease cause, and patients often continue to progress with more symptoms. Prediabetes is the early stage of diabetes and provides a good time window for intervention and prevention. However, with few symptoms, prediabetes is usually ignored without any treatment. Obviously, it is far from ideal to rely on the traditional medical system for diabetes healthcare. As a result, the medical system must be transformed from a reactive approach to a proactive approach. Root cause analysis and personalized intervention should be conducted for patients with prediabetes. Based on systems medicine, also known as P4 medicine, with a predictive, preventive, personalized, and participatory approach, new medical system is expected to significantly promote the prevention and treatment of chronic diseases such as prediabetes and diabetes. Many studies have shown that the occurrence and development of diabetes is closely related to gut microbiota. However, the relationship between diabetes and gut microbiota has not been fully elucidated. This review describes the research on the relationship between gut microbiota and diabetes and some exploratory trials on the interventions of prediabetes based on P4 medicine model. Furthermore, we also discussed how these findings might influence the diagnosis, prevention and treatment of diabetes in the future, thereby to improve the wellness of human beings.

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Current and emerging pharmacotherapy for prediabetes: are we moving forward?

Cited by 6 publications

References 57 publications

Association between prediabetes and risk of all cause mortality and cardiovascular disease: updated meta-analysis

Association between prediabetes and risk of all cause mortality and cardiovascular disease: updated meta-analysis

Correlation between prediabetes and coronary artery disease severity in patients undergoing elective coronary angiography

A P4 medicine perspective of gut microbiota and prediabetes: Systems analysis and personalized intervention

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