Prevention of Diabetes Mellitus in Patients With Prediabetes

Abstract

Cardiovascular disease is a leading cause of death among patients with diabetes. Consequently, as antidiabetic medications have demonstrated cardiovascular benefit, cardiologists have been asked to weigh in regarding antidiabetic therapy. The cardiologist's role will continue to grow as antidiabetic agents with cardiovascular benefit are being studied in prediabetes as part of an evolving clinical environment. Still, current guidelines primarily recommend high-intensity lifestyle intervention or metformin for diabetes prevention. Considering that many patients cared for by a cardiologist will have prediabetes, we propose herein that cardiologists can also facilitate diabetes prevention through direct intervention, referring patients to community-based highintensity lifestyle interventions, and through advocacy, policy, and additional guideline development. The most important messaging for a patient is that avoiding new-onset diabetes can reduce microvascular disease, reduce healthcare cost, and improve health related quality of life. Moreover, as the mortality risk of patients with a history of myocardial infarction and diabetes is almost double that of patients with a history of myocardial infarction who are free of diabetes, there is even more potential benefit in delaying/avoiding diabetes in patients with cardiovascular disease. Despite these important health advantages, the implementation of diabetes prevention strategies is lagging. The under implementation may be exaggerated by published opinions conflicting major guidelines in addition to conflicting guideline recommendations. In conclusion, we propose cardiologists can play a key role in preventing diabetes and aligning practice patterns with guideline recommendations among endocrinology, cardiology, and primary care stake holders.

Two-Year Clinical Outcomes Between Prediabetic and Diabetic Patients With STEMI and Multivessel Disease Who Underwent Successful PCI Using Drug-Eluting Stents

“…9 The patient with pre-DM is an important and not an uncommon population presenting to interventional cardiologists. 10 In patients with DM, CAD tends to be characterized by small, diffuse multivessel disease (MVD). 11 The population of these prior studies [7][8][9] was not confined to patients with ST-segment elevation myocardial infarction (STEMI).…”

Medicinal Plants, Bioactive Compounds, and Dietary Therapies for Treating Type 1 and Type 2 Diabetes Mellitus

“…Many individuals with T2DM present clinical prediabetes evidence (such as impaired glucose tolerance and/or impaired fasting glucose) prior to developing T2DM [26]. Prediabetes progression to overt T2DM could be reversed or slowed by lifestyle medications/changes, which enhance sensitivity to insulin or decrease the production of glucose in the liver [27]. T2DM is mostly because of lifestyle and environmental factors, as well as genetics [28].…”

Versorgungssituation und Mortalität von Patienten in Deutschland innerhalb und außerhalb des DMP Typ-2-Diabetes: eine kritische Analyse

“…Zudem ist es belegt, dass eine frühe Therapie mit Metformin eine weitere Eskalation der Therapie im Verlauf verzögern kann und ggf. bereits bei einem Prädiabetes infrage kommt [34,35]. Erst wenn der Einsatz von mehreren Antidiabetika in Kombination notwendig erscheint, sind differenziertere Überlegungen für den individuellen Patienten notwendig.…”