Via practica S4/2007

THE POSSIBILITIES OF PREVENTION OF TYPE 2 DIABETES MELLITUS IN SUBJECTS WITH PREDIABETIC DYSGLYCEMIAS

Type 2 diabetes mellitus is an important risk factor for cardiovascular disease. Even prediabetic dysglycemias (impaired fasting glucose – IFG and impaired glucose tolerance – IGT) are associated with an increased cardiovascular risk, and IGT is associated also with the risk of development of diabetic neuropathy. In the past 10 years multiple interventions, which led to prevention of diabetes mainly by decreasing insulin resistance, were tested. Lifestyle measures leading to the reduction of body weight were the most effective. Further, both the reduction of body weight by bariatric surgery or orlistat were effective in diabetes prevention. Among insulin sensitizing drugs, both metformin and glitazones were shown to be efficient in diabetes prevention. Among other therapeutic approaches both antidiabetic drug acarbose and treatment of hypertension by renin-angiotensin system inhibitors were also proved to have effect in the diabetes prevention. In the present time based on the above-mentioned knowledge, intensive application of the lifestyle changes is the most effective approach in patients with prediabetic dysglycemias, the majority of whom is affected by the metabolic syndrome. In case of the insufficient effectiveness of lifestyle interventions, the therapy with metformin is appropriate to achieve the therapeutic goal for HbA1c<6%.

Keywords: prediabetic dysglycemia, prevention of type 2 diabetes, insulin resistance, defect of insulin secretion.