Hyperglycaemia, pre-diabetes and diabesity: Can we choose who to ‘fast-track’ into diabetes prevention?

Abstract

Global numbers of overweight and obesity have been increasing steadily for the past few decades, driving a rapid parallel increase in type 2 diabetes (T2D) morbidity and associated mortality. Hindered by our inability to clearly define the characteristics and therefore the assessment biomarkers for ‘pre-diabetes’, there remains significant difficulty in identifying those most at risk, essential in order to prioritize public health initiatives for those who would most benefit from ‘fast-track’ prevention. Implementation of a population-wide approach to T2D prevention is likely to be prohibitively expensive and unsuccessful, so more focused strategies are required. ‘Pre-diabetes’ is defined by any/all of 4 biomarker methods, comprising impaired fasting glucose (IFG), impaired glucose tolerance (IGT), IFG plus IGT, and mildly raised HbA1c. Each definition defines quite different sub-cohorts of the population, hence quite different risk profile, and may lead to both ‘missed’ and ‘false positive’ pre- diabetics. This problem must be resolved before we are able to make substantial strides and reliably choose who is most at risk and would most benefit from ‘fast-track’ into diabetes lifestyle and or pharmaceutical prevention.