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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References
- The Strategy of Preventive Medicine.Oxford University Press, United Kingdom1992
- IDF Diabetes Atlas: global estimates for the prevalence of diabetes for 2015 and 2040.Diabetes Res Clin Pract. 2017; 128: 40-50
Canadian Diabetes Association (Canada). The cost of diabetes in Canada. Available at: http://www.diabetes.ca/CDA/media/documents/publications-and-newsletters/advocacy-reports/economic-tsunami-cost-of-diabetes-in-canada-english.pdf. Accessed March 21, 2018.
- National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States, 2014.Department of Health and Human Services, Atlanta GA2014
- Canadian Diabetes Association 2013 clinical practice guidelines for the prevention and management of diabetes in Canada: screening for type 1 and type 2 diabetes.Can J Diabetes. 2013; 37: S12-S15
- 2. Classification and diagnosis of diabetes.Diabetes Care. 2017; 40: S11-24
- ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: the Task Force on diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in collaboration with the European Association for the Study of Diabetes (EASD) [erratum in 2014;35:1824].Eur Heart J. 2013; 34: 3035-3087
- Prediction models for risk of developing type 2 diabetes: systematic literature search and independent external validation study.BMJ. 2012; 345: e5900
- Association of impaired fasting glucose and coronary artery calcification as a marker of subclinical atherosclerosis in a population-based cohort—results of the Heinz Nixdorf Recall Study.Diabetologia. 2009; 52: 81-89
- Long-term pioglitazone treatment for patients with nonalcoholic steatohepatitis and prediabetes or type 2 diabetes mellitus: a randomized trial.Ann Intern Med. 2016; 165: 305-315
- Quantifying the duration of pre-diabetes.Aust N Z J Public Health. 2010; 34: 311-314
- Delayed initiation of subcutaneous insulin therapy after failure of oral glucose-lowering agents in patients with type 2 diabetes: a population-based analysis in the UK.Diabet Med. 2007; 24: 1412-1418
- Clinical application of incretin-based therapy: therapeutic potential, patient selection and clinical use.Am J Med. 2009; 122: S37-50
- The natural history of insulin secretory dysfunction and insulin resistance in the pathogenesis of type 2 diabetes mellitus.J Clin Invest. 1999; 104: 787-794
- β-Cell function in subjects spanning the range from normal glucose tolerance to overt diabetes: a new analysis.J Clin Endocrinol Metab. 2005; 90: 493-500
- U.K. prospective diabetes study 16. Overview of 6 years' therapy of type II diabetes: a progressive disease. U.K. Prospective Diabetes Study Group.Diabetes. 1995; 44: 1249-1258
- We can change the natural history of type 2 diabetes.Diabetes Care. 2014; 37: 2668-2676
- Long-term effects of lifestyle intervention or metformin on diabetes development and microvascular complications over 15-year follow-up: the Diabetes Prevention Program Outcomes Study.Lancet Diabetes Endocrinol. 2015; 3: 866-875
- Short-term intensive insulin therapy in type 2 diabetes mellitus: a systematic review and meta-analysis.Lancet Diabetes Endocrinol. 2013; 1: 28-34
- Intensive insulin therapy in newly diagnosed type 2 diabetes.Lancet. 2008; 371: 1725-1726
- Patient-accessible tool for shared decision making in cardiovascular primary prevention: balancing longevity benefits against medication disutility.Circulation. 2014; 129: 2539-2546
- Effect of patients' risks and preferences on health gains with plasma glucose level lowering in type 2 diabetes mellitus.JAMA Intern Med. 2014; 174: 1227-1234
- Cardiovascular mortality, all-cause mortality, and diabetes incidence after lifestyle intervention for people with impaired glucose tolerance in the Da Qing Diabetes Prevention Study: a 23-year follow-up study.Lancet Diabetes Endocrinol. 2014; 2: 474-480
- Improved lifestyle and decreased diabetes risk over 13 years: long-term follow-up of the randomised Finnish Diabetes Prevention Study (DPS).Diabetologia. 2013; 56: 284-293
- Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.N Engl J Med. 2002; 346: 393-403
- Prevention of type 2 diabetes by lifestyle intervention: a Japanese trial in IGT males.Diabetes Res Clin Pract. 2005; 67: 152-162
- The Indian Diabetes Prevention Programme shows that lifestyle modification and metformin prevent type 2 diabetes in Asian Indian subjects with impaired glucose tolerance (IDPP-1).Diabetologia. 2006; 49: 289-297
- Lifestyle modification and prevention of type 2 diabetes in overweight Japanese with impaired fasting glucose levels: a randomized controlled trial.Arch Intern Med. 2011; 171: 1352-1360
- Effectiveness of mobile phone messaging in prevention of type 2 diabetes by lifestyle modification in men in India: a prospective, parallel-group, randomised controlled trial.Lancet Diabetes Endocrinol. 2013; 1: 191-198
- Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance: the Da Qing IGT and Diabetes Study.Diabetes Care. 1997; 20: 537-544
- Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance.N Engl J Med. 2001; 344: 1343-1350
- The long-term effect of lifestyle interventions to prevent diabetes in the China Da Qing Diabetes Prevention Study: a 20-year follow-up study.Lancet. 2008; 371: 1783-1789
- Diabetes duration and cause-specific mortality in the Verona Diabetes Study.Diabetes Care. 2000; 23: 1119-1123
- Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes [erratum in 2014;370:1866].N Engl J Med. 2013; 369: 145-154
- TRIPOD (TRoglitazone In the Prevention Of Diabetes): a randomized, placebo-controlled trial of troglitazone in women with prior gestational diabetes mellitus.Control Clin Trials. 1998; 19: 217-231
- Effect of ramipril on the incidence of diabetes.N Engl J Med. 2006; 355: 1551-1562
- Pioglitazone does not enhance the effectiveness of lifestyle modification in preventing conversion of impaired glucose tolerance to diabetes in Asian Indians: results of the Indian Diabetes Prevention Programme-2 (IDPP-2).Diabetologia. 2009; 52: 1019-1026
- Low-dose combination therapy with rosiglitazone and metformin to prevent type 2 diabetes mellitus (CANOE trial): a double-blind randomised controlled study.Lancet. 2010; 376: 103-111
- Pioglitazone for diabetes prevention in impaired glucose tolerance.N Engl J Med. 2011; 364: 1104-1115
- Acarbose for prevention of type 2 diabetes mellitus: the STOP-NIDDM randomised trial.Lancet. 2002; 359: 2072-2077
- Voglibose for prevention of type 2 diabetes mellitus: a randomised, double-blind trial in Japanese individuals with impaired glucose tolerance.Lancet. 2009; 373: 1607-1614
- Basal insulin and cardiovascular and other outcomes in dysglycemia.N Engl J Med. 2012; 367: 319-328
- A randomized, controlled trial of 3.0 mg of liraglutide in weight management.N Engl J Med. 2015; 373: 11-22
- Xenical in the prevention of diabetes in obese subjects (XENDOS) study.Diabetes Care. 2004; 27: 155-161
- Effect of nateglinide on the incidence of diabetes and cardiovascular events.N Engl J Med. 2010; 362: 1463-1476
- Preservation of pancreatic β-cell function and prevention of type 2 diabetes by pharmacological treatment of insulin resistance in high-risk Hispanic women.Diabetes. 2002; 51: 2796-2803
- Effect of rosiglitazone on the frequency of diabetes in patients with impaired glucose tolerance or impaired fasting glucose: a randomised controlled trial [erratum in 2006;368:1770].Lancet. 2006; 368: 1096-1105
- Long-term effect of rosiglitazone and/or ramipril on the incidence of diabetes.Diabetologia. 2011; 54: 487-495
- Changes over time in glycemic control, insulin sensitivity, and beta-cell function in response to low-dose metformin and thiazolidinedione combination therapy in patients with impaired glucose tolerance.Diabetes Care. 2011; 34: 1601-1604
- Thiazolidinediones and cancer: results of a meta-analysis of randomized clinical trials.Acta Diabetol. 2014; 51: 91-101
- Pioglitazone and bladder cancer risk: a multipopulation pooled, cumulative exposure analysis.Diabetologia. 2015; 58: 493-504
- Dipeptidyl-peptidase (DPP)-4 inhibitors and glucagon-like peptide (GLP)-1 analogues for prevention or delay of type 2 diabetes mellitus and its associated complications in people at increased risk for the development of type 2 diabetes mellitus.Cochrane Database Syst Rev. 2017; 5: CD012204
- Acarbose treatment and the risk of cardiovascular disease and hypertension in patients with impaired glucose tolerance: the STOP-NIDDM Trial.JAMA. 2003; 290: 486-494
- Effect of valsartan on the incidence of diabetes and cardiovascular events [erratum in 2010;362:1748].N Engl J Med. 2010; 362: 1477-1490
- Relationships between fasting plasma glucose levels and insulin secretion during intravenous glucose tolerance tests.J Clin Endocrinol Metab. 1976; 42: 222-229
- Effect of intensive insulin therapy on β-cell function and glycaemic control in patients with newly diagnosed type 2 diabetes: a multicentre randomised parallel-group trial.Lancet. 2008; 371: 1753-1760
- Predictors of sustained drug-free diabetes remission over 48 weeks following short-term intensive insulin therapy in early type 2 diabetes.BMJ Open Diabetes Res Care. 2016; 4: e000270
- Diabetes and weight in comparative studies of bariatric surgery vs conventional medical therapy: a systematic review and meta-analysis.Obes Surg. 2014; 24: 437-455
- Treatment of mild to moderate obesity with laparoscopic adjustable gastric banding or an intensive medical program: a randomized trial.Ann Intern Med. 2006; 144: 625-633
- 2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children [summary].CMAJ. 2007; 176: S1-13
- Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient–2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery.Obesity (Silver Spring). 2013; 21: S1-27
Article info
Publication history
Published online: January 15, 2018
Accepted:
December 10,
2017
Received:
October 31,
2017
Footnotes
See page 621 for disclosure information.
Identification
Copyright
© 2018 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
