Chianelli Marco, Armellini Marina, Carpentieri Maria, Coccaro Carmela, Cuttica Carla Micaela, Fusco Alessandra, Marucci Simonetta, Nelva Anna, Nizzoli Maurizio, Ponziani Maria Chantal, Sciaraffia Marcello, Tassone Francesco, Busetto Luca
Unit of Endocrinology and Metabolism, Regina Apostolorum Hospital, Albano, Rome, Italy.
Endocrinology and Metabolism Unit, University-Hospital S. Maria della Misericordia, Udine, Italy.
Endocr Metab Immune Disord Drug Targets. 2025;25(1):8-36. doi: 10.2174/0118715303282327240507184902.
Obesity and prediabetes affect a substantial part of the general population, but are largely underdiagnosed, underestimated, and undertreated. Prediabetes differs from diabetes only in the degree of hyperglycaemia consequent to the progressive decline in residual beta-cell function. Both prediabetes and diabetes occur as a consequence of insulin resistance that starts several years before the clinical onset of overt diabetes. Macrovascular complications in patients with diabetes are mainly caused by insulin resistance. This is why in prediabetes, the overall cardiovascular risk is, by all means, similar to that in patients with diabetes. It is important, therefore, to identify prediabetes and treat patients not only to prevent or delay the onset of diabetes, but to reduce the cardiovascular risk associated with prediabetes. This review provides an overview of the pathophysiology of prediabetes in patients with obesity and the progression toward overt diabetes. We have reviewed nutritional and pharmacological approaches to the management of obesity and reduced glucose tolerance, and the treatment of the major comorbidities in these patients, including hypertension, dyslipidaemia, and Metabolic dysfunction-associated Steatotic Liver Disease (MASLD), has also been reviewed. In patients with obesity and prediabetes, the nutritional approach is similar to that adopted for patients with obesity and diabetes; treatments of dyslipidaemia and hypertension also have the same targets compared to patients with diabetes. MASLD is a critical issue in these patients; in the prediabetic state, MASLD rarely progresses into fibrosis. This highlights the importance of the early recognition of this pathological condition before patients become diabetic when the risk of fibrosis is much higher. It is necessary to raise awareness of the clinical relevance of this pathological condition in order to prompt early intervention before complications occur. The single most important therapeutic goal is weight loss, which must be early and persistent.
肥胖症和糖尿病前期影响着相当一部分普通人群，但在很大程度上未得到充分诊断、低估和治疗。糖尿病前期与糖尿病的区别仅在于，随着残余β细胞功能的逐渐下降，血糖升高的程度不同。糖尿病前期和糖尿病都是胰岛素抵抗的结果，胰岛素抵抗在明显糖尿病临床发作前数年就已开始。糖尿病患者的大血管并发症主要由胰岛素抵抗引起。这就是为什么在糖尿病前期，总体心血管风险无论如何都与糖尿病患者相似。因此，识别糖尿病前期并治疗患者不仅对于预防或延缓糖尿病的发作很重要，而且对于降低与糖尿病前期相关的心血管风险也很重要。本综述概述了肥胖症患者糖尿病前期的病理生理学以及向明显糖尿病的进展。我们回顾了管理肥胖症和糖耐量降低的营养和药理学方法，并且还回顾了这些患者主要合并症的治疗，包括高血压、血脂异常和代谢功能障碍相关脂肪性肝病（MASLD）。在肥胖症和糖尿病前期患者中，营养方法与肥胖症和糖尿病患者所采用的方法相似；与糖尿病患者相比，血脂异常和高血压的治疗目标也相同。MASLD是这些患者中的一个关键问题；在糖尿病前期状态下，MASLD很少进展为纤维化。这凸显了在患者患糖尿病之前，当纤维化风险高得多时，早期识别这种病理状况的重要性。有必要提高对这种病理状况临床相关性的认识，以便在并发症发生之前促使早期干预。最重要的单一治疗目标是减肥，而且必须尽早并持续进行。
