Searching for Prediabetes Before Diabetes

Type 2 Diabetes Mellitus (T2DM) and pre diabetes prevalence is increasing worldwide at an alarming rate. Though many risk factors have been identified, the most appropriate strategy to identify when and who should undergo a more accurate screening, which could allow an earlier diagnosis and a more efficient prevention of complications, is still a matter of debate. In this review we present data from a cohort of 2126 asymptomatic non diabetic subjects, who underwent an Oral Glucose Tolerance Test (OGTT). We have discussed our results sub-classifying our population according to the risk factors for diabetes development previously proposed by the American Diabetes Association. According to our data, OGTT is able to identify a substantial proportion of subjects with prediabetic conditions who, if untreated, could progress to overt T2DM and potentially encounter serious health problems, even in non-at risk subgroups, such as subjects with a normal fasting glucose, who have a normal lipid profile and arterial pressure, who do not have a familiar history of diabetes and who do not fulfil classification criteria for metabolic syndrome. Interestingly, a further proportion of subjects fulfil OGTT criteria for diagnosis of T2DM in each of these subgroups. Therefore, we believe that OGTT execution should be advocated as a screening test in asymptomatic populations to search prediabetes before diabetes.