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Canadian Journal of Cardiology

Prediabetes

  • Aditya K. Khetan
    Affiliations
    Harrington Heart and Vascular Institute, Division of Cardiovascular Medicine, Cleveland, Ohio, USA
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  • Sanjay Rajagopalan
    Correspondence
    Corresponding author: Dr Sanjay Rajagopalan, Harrington Heart and Vascular Institute, University Hospitals, Case Cardiovascular Research Institute, Wolstein Research Building, Rm 4405, Cleveland, Ohio 44106, USA. Tel.: +1-216-844-3800.
    Affiliations
    Harrington Heart and Vascular Institute, Division of Cardiovascular Medicine, Cleveland, Ohio, USA
    Search for articles by this author
Published:January 15, 2018DOI:https://doi.org/10.1016/j.cjca.2017.12.030

      Abstract

      The burden of diabetes is expected to rise from 415 million individuals in 2015 to 642 million individuals by 2040. Most individuals pass through a phase of prediabetes before developing full-blown diabetes. Insulin resistance, impaired incretin action, and insulin hypersecretion are central to the pathophysiology of prediabetes. Individuals older than 40 years of age and other high-risk individuals should be screened for diabetes with fasting plasma glucose and/or hemoglobin A1c. For those diagnosed with prediabetes, the goal of treatment should be restoring euglycemia, because there are data showing that restoring normoglycemia during prediabetes and early diabetes can produce lasting remission. The preferred approach for this is intensive lifestyle intervention, which besides reducing progression to diabetes, has also been shown to reduce all-cause mortality in a long-term follow-up study. The best evidence for a pharmacological approach is with metformin. Other drugs that have shown efficacy include thiazolidinediones, alpha-glucosidase inhibitors, orlistat, basal insulin, and valsartan. However, except for metformin, none of these drugs are currently recommended for this purpose. Newer agents such as glucagon-like peptide-1 agonists and dipeptidyl peptidase 4 (DPP-4) inhibitors also have considerable promise in this area. Bariatric surgery can be offered to patients with metabolic syndrome and body mass index of 30-35.

      Résumé

      On s’attend à ce que le fardeau du diabète passe de 415 millions de personnes en 2015 à 642 millions de personnes en 2040. La plupart des individus traversent une phase de prédiabète avant de développer un véritable diabète. L’insulinorésistance, la dégradation de l’activité des incrétines et l’hypersécrétion d’insuline sont au centre de la physiopathologie du prédiabète. Les personnes de plus de 40 ans et les autres personnes exposées à un risque élevé devraient subir un dépistage du diabète au moyen de la glycémie plasmatique à jeun ou de l’hémoglobine glyquée (A1c), ou les deux. Chez les personnes ayant un diagnostic de prédiabète, l’objectif du traitement devrait être le rétablissement de l’euglycémie, puisque des données montrent que le rétablissement de la normoglycémie au cours du prédiabète et du diabète précoce peut entraîner une rémission durable. L’approche privilégiée pour atteindre cet objectif de traitement demeure l’intervention intensive sur le mode de vie qui, en plus de ralentir la progression du diabète, s’est avérée efficace pour réduire la mortalité toutes causes confondues lors d’une étude de suivi à long terme. Les meilleures données probantes d’approche pharmacologique montrent l’efficacité de la metformine. Parmi les autres médicaments qui ont démontré leur efficacité, notons : les thiazolidinediones, les inhibiteurs des alpha-glucosidases, l’orlistat, l’insuline basale et le valsartan. Toutefois, à l’exception de la metformine, aucun de ces médicaments n’est actuellement recommandé à cette fin. Des agents plus récents tels que les agonistes des récepteurs GLP-1 (glucagon-like peptide-1) et les inhibiteurs de la DPP-4 (dipeptidyl peptidase 4) sont également très prometteurs dans ce domaine. La chirurgie bariatrique peut être offerte aux patients atteints du syndrome métabolique dont l’indice de masse corporelle se situe entre 30 et 35.
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