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REVIEW  SUBCLINICAL ENDOCRINE DISEASE: OLD AND NEW CLINICAL SCENARIOS 

Minerva Endocrinology 2021 September;46(3):272-92

DOI: 10.23736/S2724-6507.21.03405-9

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

Prediabetes: how pathophysiology drives potential intervention on a subclinical disease with feared clinical consequences

Gianfranco DI GIUSEPPE 1, 2, Gea CICCARELLI 1, 2, Chiara M. CEFALO 1, 2, Francesca CINTI 1, 2, Simona MOFFA 1, 2, Flavia IMPRONTA 1, 2, Umberto CAPECE 1, 2, Alfredo PONTECORVI 1, 2, Andrea GIACCARI 1, 2, Teresa MEZZA 1, 2

1 Endocrinologia e Diabetologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; 2 Dipartmento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy



INTRODUCTION: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder whose rising incidence suggests the epidemic proportions of the disease. Impaired fasting glucose (IFG) and Impaired Glucose Tolerance (IGT) - alone or combined - represent two intermediate metabolic condition between Normal Glucose Tolerance (NGT) and overt T2DM.
EVIDENCE ACQUISITION: Databases were systematically screened using the following MeSH terms combination as follows: 1. prediabetes, 2. prediabetic state, 3. prevention, 4. lifestyle, 5. diet, 6. nutrition, 7. pharmacotherapy, 8. metformin, 9. thiazolidinediones, 10. sodium glucose cotransporter 2 inhibitors, 11. GLP 1 receptor agonists, 12. alpha glucosidase inhibitors, 13. insulin, 14. DPP IV inhibitors.
EVIDENCE SYNTHESIS: Several studies have demonstrated that insulin resistance and beta-cell impairment can be identified even in normoglycemic prediabetic individuals. Worsening of these two conditions may lead to progression of IGT and/or IFG status to overt diabetes. Starting from these assumptions, it seems logical to suppose that interventions aimed at improving metabolic conditions, even in prediabetes, could represent an effective target to halt transition from IGT/IFG to manifest T2DM. Starting from pathophysiological knowledge, in this review we evaluate two possible interventions (lifestyle modifications and pharmacological agents) eligible as prediabetes therapy since they have been demonstrated to improve insulin resistance and beta-cell impairment.
CONCLUSIONS: Detecting high-risk people and treating them could represent an effective strategy to slow down progression to overt diabetes, normalize glucose tolerance, and even prevent micro- and macrovascular complications.


KEY WORDS: Prediabetic state; Pancreatic diseases; Diabetes mellitus, type 2; Diabetes, prevention and control

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