The time is now for new, lower diabetes diagnostic thresholds

Schwartz, Stanley; Rachfal, Amy W.; Corkey, Barbara E.

doi:10.1016/j.tem.2021.10.007

Cited by 8 publications

(7 citation statements)

References 15 publications

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“…Some endorse the current definition [ 3 ], whereas others propose to rethink the approach to identify people at risk by including more markers of risk [ 8 ], while others want to abandon the prediabetes concept entirely [ 2 ]. It has even been suggested to lower the diagnostic threshold of diabetes to include the prediabetic range [ 9 ]. All these alternatives may have both positive and negative consequences (electronic supplementary material [ESM] Table 1 ).…”

Section: Introductionmentioning

confidence: 99%

The prediabetes conundrum: striking the balance between risk and resources

et al. 2023

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The current definition of prediabetes is controversial and subject to continuous debate. Nonetheless, prediabetes is a risk factor for type 2 diabetes, is highly prevalent and is associated with diabetic complications and mortality. Thereby, it has the potential to become a huge strain on healthcare systems in the future, necessitating action from legislators and healthcare providers. But how do we best reduce its associated burden on health? As a compromise between differing opinions in the literature and among the authors of this article, we suggest stratifying individuals with prediabetes according to estimated risk and only offering individual-level preventive interventions to those at high risk. At the same time, we argue to identify those with prediabetes and already established diabetes-related complications and treat them as we would treat individuals with established type 2 diabetes. Graphical abstract

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Section: Introductionmentioning

confidence: 99%

The prediabetes conundrum: striking the balance between risk and resources

et al. 2023

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“…There are presently 463 million persons worldwide with diabetes mellitus, representing 9.3% of the adult population, with an expected doubling in the next 25 years ( 1 ), and with approximately 37% of US adults older than 20 years and 51% older than 65 having prediabetes with predicted high rates of conversion to type 2DM with passing years ( 2 ). Because of this, prediabetes, along with diabetes, are now recognized as a major risk factor for the development and progression of retinal and brain neurovascular injury ( 3 – 7 ), resulting in severe vision loss ( 8 ) as well as moderate vascular cognitive impairment with progression to dementia ( 4 , 7 , 9 ). The focus of the medical industry has predominantly been to examine the effect of control of hyperglycemia along with other aggravating factors (hypertension, smoking, obesity, and hyperlipidemia) on the progression of large vessel occlusive disease, because of the rising incidence of stroke and myocardial infarction ( 10 ).…”

Section: Introductionmentioning

confidence: 99%

Diabetes mellitus associated neurovascular lesions in the retina and brain: A review

Sinclair

Miller²,

Talekar³

et al. 2022

Front. Ophthalmol.

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Diabetes mellitus (DM) is now recognized as a system-wide, autoimmune, inflammatory, microvascular disorder, which, in the retina and brain results in severe multifocal injury now recognized as a leading cause, world-wide, of progressive vision loss and dementia. To address this problem, resulting primarily from variations in glycemia in the prediabetic and overt diabetic states, it must be realized that, although some of the injury processes associated with diabetes may be system wide, there are varying responses, effector, and repair mechanisms that differ from organ to organ or within varying cell structures. Specifically, within the retina, and similarly within the brain cortex, lesions occur of the “neurovascular unit”, comprised of focal microvascular occlusions, inflammatory endothelial and pericyte injury, with small vessel leakage resulting in injury to astrocytes, Müller cells, and microglia, all of which occur with progressive neuronal apoptosis. Such lesions are now recognized to occur before the first microaneurysms are visible to imaging by fundus cameras or before they result in detectable symptoms or signs recognizable to the patient or clinician. Treatments, therefore, which currently are not initiated within the retina until edema develops or there is progression of vascular lesions that define the current staging of retinopathy, and in the brain only after severe signs of cognitive failure. Treatments, therefore are applied relatively late with some reduction in progressive cellular injury but with resultant minimal vision or cognitive improvement. This review article will summarize the multiple inflammatory and remediation processes currently understood to occur in patients with diabetes as well as pre-diabetes and summarize as well the current limitations of methods for assessing the structural and functional alterations within the retina and brain. The goal is to attempt to define future screening, monitoring, and treatment directions that hopefully will prevent progressive injury as well as enable improved repair and attendant function.

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“…Diabetes mellitus, therefore, is now recognized to involve a systemic, autoimmune, inflammatory disorder causing focal microvascular occlusions and alterations of the blood-retinal and blood-brain barriers, that occur in the "pre-diabetic" as well as diabetic individuals [1,87,108,109]. In the Diabetes Prevention Program (DPP), 7.9% of subjects with impaired glucose tolerance had retinopathy [110], similar to the 8.1% prevalence of retinopathy observed among individuals with prediabetes in the Gutenberg Health Study [111] with the variability of the glycemia a significant recognized risk factor for both development and progression [112,113].…”

Section: Pathologic Mechanisms Implicated In the Development Of Retin...mentioning

confidence: 99%

Diabetes Mellitus Associated Progressive Neurovascular Retinal Injury: Recommendations for Imaging and Functional Testing and Potential Role for Early Intervention with Modern Retinal Laser Therapy

Sinclair¹,

Luttrull²

2022

J Opht Res Rev Rep

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Diabetes mellitus is now recognized as a systemic, autoimmune, microvascular disorder, which, in the retina results in severe, multifocal injury now recognized as a leading cause, world-wide, of progressive vision loss. To address this problem in the prediabetic and overt diabetic states, it must be realized that, although the injury processes may be system wide, there are varying responses, effector, and repair mechanisms that differ from organ to organ or within varying cell structures. Specifically, within the “neurovascular unit” of the retina, lesions occur of focal microvascular occlusions, inflammatory endothelial and pericyte injury, and small vessel leakage resulting in injury to astrocytes, Müller cells, microglia, and causing progressive neuronal apoptosis. Such lesions are now recognized to occur before the first microaneurysms are visible by fundus camera imaging or before detectable symptoms or signs recognizable to the patient or clinician. Treatments, therefore which currently are not initiated until edema develops or progressive vascular occlusion, are applied relatively late with some reduction in progressive cellular injury but with minimal vision improvement.

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The time is now for new, lower diabetes diagnostic thresholds

Cited by 8 publications

References 15 publications

The prediabetes conundrum: striking the balance between risk and resources

The prediabetes conundrum: striking the balance between risk and resources

Diabetes mellitus associated neurovascular lesions in the retina and brain: A review

Diabetes Mellitus Associated Progressive Neurovascular Retinal Injury: Recommendations for Imaging and Functional Testing and Potential Role for Early Intervention with Modern Retinal Laser Therapy

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