How, when, and with what treatment should prediabetes be treated?

Abstract

Prediabetes is associated not only with an increased risk of developing diabetes but also with a higher incidence of microvascular and macrovascular events. It is often accompanied by comorbidities that require attention and treatment. Excluding the subset of patients who require pharmacological treatment due to the presence of these comorbid or associated conditions (e.g., hyperlipidemia, hypertension, coronary artery disease, heart or kidney failure, etc.), the management of the glycemic abnormalities characteristic of prediabetic states presents unresolved challenges and questions: not all patients respond equally to pharmacological treatment, and those who do may not respond for the same duration.

Proper treatment of obesity and lifestyle modifications are critical. However, several uncertainties remain regarding long-term outcomes: How can the effects of lifestyle changes be enhanced and made more lasting?, Who should receive pharmacological treatment?, What are the goals of these pharmacological interventions?, Is the goal to restore normal glycemic levels?, What role do these interventions play in preventing the development of clinical diabetes and prediabetic micro- and macrovascular complications?, To what extent is this achievable?, What can be expected from new pharmacological developments in this area and in the treatment of obesity?.

This is a relevant discussion with a significant impact not only clinically but also socially, particularly within the realm of health economics, given the high prevalence of this clinical condition.