Impaired Fasting Glucose and Impaired Glucose Tolerance

Implications for care

  1. David M. Nathan, MD1,
  2. Mayer B. Davidson, MD2,
  3. Ralph A. DeFronzo, MD3,
  4. Robert J. Heine, MD, PHD, FRCP4,
  5. Robert R. Henry, MD5,
  6. Richard Pratley, MD6 and
  7. Bernard Zinman, MD7
  1. 1Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
  2. 2Clinical Center for Research Excellence, Charles R. Drew University of Medicine and Science, Los Angeles, California
  3. 3University of Texas Health Science Center, San Antonio, Texas
  4. 4Diabetes Center, VU University Medical Center, Amsterdam, the Netherlands
  5. 5Department of Medicine, University of California, San Diego, California
  6. 6Department of Medicine, University of Vermont, Burlington, Vermont
  7. 7Departments of Endocrinology and Metabolism, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
  1. Address correspondence to Richard Kahn, American Diabetes Association, 1701 North Beauregard St., Alexandria, VA 22311. E-mail: rkahn{at}diabetes.org

Type 2 diabetes is now epidemic. In the U.S., there has been a 61% increase in incidence between 1990 and 2001 (1). There are currently 1.5 million new cases per year, and the prevalence in 2005 was almost 21 million (2). The epidemic has affected developed and developing countries alike, and the worldwide prevalence of diabetes is projected to increase dramatically by 2025 (3). The increase in type 2 diabetes is related to lifestyle changes that have resulted in overweight, obesity, and decreased physical activity levels. These environmental changes, superimposed on genetic predisposition, increase insulin resistance, which, in concert with progressive β-cell failure, results in rising glycemia in the nondiabetic range. In addition to the risk for diabetes, insulin resistance and impaired insulin secretion are accompanied by a host of major cardiovascular disease (CVD) risk factors including hypertension and dyslipidemia. Further reduction in insulin secretion over time results in increasing glycemia and the development of diabetes, which in turn is associated with the development of microvascular and cardiovascular complications.

The transition from the early metabolic abnormalities that precede diabetes, impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), to diabetes may take many years; however, current estimates indicate that most individuals (perhaps up to 70%) with these pre-diabetic states eventually develop diabetes (4–10). During the pre-diabetic state, the risk of a CVD event is modestly increased (11–22). With the development of diabetes, however, there is a large increase in risk for CVD, as well as for long-term complications affecting the eyes, kidneys, and nervous system. The complications of diabetes, which are the cause of major morbidity and mortality, are related to its duration, chronic level of glycemia, and other risk factors.

Although clinical trials have demonstrated the effectiveness of intensive glycemic and blood pressure control to …

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