Prediabetes: never too early to intervene

A diagnosis of type 2 diabetes is usually preceded by several years of impaired glucose regulation referred to as prediabetes or intermediate hyperglycaemia. Prediabetes is variously defined by different organisations as an HbA1c of 5·7–6·4% (39–47 mmol/mol) or 6·0–6·4% (42–47 mmol/mol), and is characterised by impaired glucose tolerance (2-h 75 g oral glucose tolerance test with a plasma glucose of 7·8–11·0 mmol/L) or impaired fasting glucose (usually defined as fasting plasma glucose of 6·1–6·9 mmol/L). 1 Echouffo-Tcheugui JB Selvin E Prediabetes and what it means: the epidemiological evidence. Ann Rev Public Health. 2021; 42: 59-77 Crossref PubMed Scopus (62) Google Scholar Without adequate intervention, prediabetes will progress into type 2 diabetes at a rate of 5–10% per year or faster for certain ethnicities (eg, South and East Asian people) and individuals who are older, have overweight, or have glycaemic values already close to the boundary of diabetes. Interventions with lifestyle measures with or without certain glucose-lowering or weight-lowering medications can defer, prevent, or reverse the progression to diabetes. 2 Richter B Hemmingsen B Metzendorf MI Takwoingi Y Development of type 2 diabetes mellitus in people with intermediate hyperglycaemia. Cochrane Database Syst Rev. 2018; 10CD012661 PubMed Google Scholar , 3 Lawa Y Bello F Kaoje YS Prediabetes deserves more attention: a review. Clin Diabetes. 2020; 38: 328-338 Crossref PubMed Scopus (6) Google Scholar However, debate continues over whom and when to screen and how to intervene. Safety and effectiveness of metformin plus lifestyle intervention compared with lifestyle intervention alone in preventing progression to diabetes in a Chinese population with impaired glucose regulation: a multicentre, open-label, randomised controlled trialMetformin plus lifestyle intervention further reduced the risk of developing diabetes than lifestyle intervention alone in Chinese people with impaired glucose regulation, showing additional benefits of combined intervention in preventing progression to diabetes without new safety concerns. Full-Text PDF