This expert review frames as an early, reversible syndrome stage where lifestyle change, metformin, and weight-loss drugs may prevent diabetes.
Evidence
Expert recommendations synthesize clinical studies, meta-analyses, guidelines, and pharmacotherapy evidence for people with prediabetes, with emphasis on the United Arab Emirates context.
Caveat
The paper is a recommendation review rather than a new trial, and incretin agonist use is limited by uncertainty about treatment duration and management after withdrawal.
Simplified
The emerging concept of the cardiovascular-kidney-metabolic () syndrome encapsulates the interrelated nature of metabolic processes and metabolic dysfunction. , which describes the presence of elevations of blood glucose measurements insufficient to provoke a diagnosis of type 2 diabetes (T2D), is an important, - and crucially, reversible - early manifestation of the CKM syndrome. Numerous clinical studies and meta-analyses have shown that a substantial minority of people with prediabetes have microvascular and/or macrovascular complications reminiscent of those seen in clinical T2D. Prediabetes therefore represents an early stage of a continuum of increased insulin resistance, hyperglycaemia and associated vascular risk that begins at blood glucose concentrations that are well below those required for a diagnosis of diabetes. This condition also provides an opportunity for early intervention. All people with prediabetes should receive a multifactorial lifestyle intervention that focuses of weight management, nutrition, physical activity and smoking cessation. Where this is insufficient, ineffective or not followed, metformin remains the best studied pharmacotherapy for the management of prediabetes, with formal therapeutic indications for this purpose in many countries and support within international guidelines. Weight management is crucial for diabetes prevention, and weight loss during receipt of incretin agonist drugs is effective in diabetes prevention in populations with prediabetes, although consideration should be given to how long the treatment should be maintained and how the patient should be managed when it is ultimately withdrawn.
Key numbers
18.3%
Prevalence
Percentage of in the UAE population.
–31%
Risk Reduction with Metformin
Reduction in risk of conversion from IGT to T2D with metformin.
Full Text
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MH attended educational activities and/or advisory board meetings for Abbott, Bayer, Lilly, Novo Nordisk, Sanofi, Boehringer Ingelheim, Merck, MSD and Medtronic. RK is a full-time employee of Merck Serono Middle East FZ-LLC, Dubai, United Arab Emirates, an affiliate of Merck KGaA, Darmstadt, Germany. KMGB is a full-time employee of Merck Healthcare KGaA, Darmstadt, Germany. The authors report no other conflicts of interest in this work.
