Diabetes, prediabetes, and cardiovascular risk: Shifting the paradigm

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.amjmed.2005.05.018 Byline: Prakash C. Deedwania (a), Vivian A. Fonseca (b) Keywords: Diabetes; Metabolic syndrome; Glucose intolerance; Cardiovascular disease Abstract: As the prevalence of diabetes continues to increase worldwide, diabetes-related macrovascular morbidity and mortality are becoming major health care problems. Epidemiologic evidence suggests this relationship begins early in the progression from normal glucose tolerance to frank diabetes. This report reviews this epidemiologic evidence linking early stages of glucose dysregulation with cardiovascular disease and discusses the results of major clinical trials demonstrating that lifestyle or pharmacologic intervention can reduce the incidence of diabetes in high-risk individuals. These observations indicate that early identification and aggressive treatment of subjects with impaired fasting glucose or impaired glucose tolerance have the potential to reduce both the incidence of diabetes and its related cardiovascular disease. Three clinical trials are being conducted to test whether early pharmacotherapy can reduce or delay the incidence of diabetes, and their results may well begin to shift the treatment paradigm toward earlier intervention. Author Affiliation: (a) Division of Cardiology, Department of Medicine, Veterans Affairs Central California Health Care System, University of California San Francisco Medical Education Program, Fresno, Calif (b) Diabetes Program, Tulane University Medical Center, New Orleans, La Article History: Received 4 February 2005; Revised 4 May 2005; Accepted 4 May 2005