Marx Nikolaus, Rydén Lars, Federici Massimo, Marx-Schütt Katharina, Verket Marlo, Müller-Wieland Dirk, Gerstein Hertzel C, Chan Juliana, Cosentino Francesco, Holman Rury R, Mellbin Linda, Ray Kausik K, Standl Eberhard, Verma Subodh, Wood David, Tuomilehto Jaakko, De Caterina Raffaele
Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen, Pauwelsstraße 30, D-52074, Aachen, Germany.
Unit of Cardiology, Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden.
Eur Heart J. 2024 Dec 23;45(48):5117-5126. doi: 10.1093/eurheartj/ehae533.
With the increasing burden of diabetes as a cause of macro- and microvascular disease linked to the epidemics of obesity, attention is being paid to dysglycaemic states that predict and precede the development of type 2 diabetes. Such conditions, termed pre-diabetes, are characterized by fasting plasma glucose, or plasma glucose levels on an oral glucose tolerance test, or values of glycated haemoglobin intermediate between 'normal' values and those characterizing diabetes. These last are by definition associated, in epidemiological terms, with a higher incidence of microvascular disease-mostly retinopathy. Pre-diabetes overlaps with the components of the 'metabolic syndrome'-among which are excess visceral adiposity; hypertension; hypertriglyceridaemia; high levels of small, dense low-density lipoproteins; and metabolic-associated fatty liver disease. There is little doubt that pre-diabetes has important prognostic implications, especially for the occurrence of myocardial infarction, ischaemic stroke, and peripheral arterial disease. It is disputed, however, whether pre-diabetes is itself an actionable disease entity, in addition to the risk factors characterizing it. Because of this uncertainty, the latest European Society of Cardiology guidelines chose not to include pre-diabetes as a treatment target for atherosclerotic cardiovascular disease, at variance from the three previous editions of such guidelines. This is spurring a debate, the Pro and Contra arguments featured in the present debate article.
随着糖尿病作为肥胖流行相关的大血管和微血管疾病病因的负担日益加重，人们开始关注那些预示并先于2型糖尿病发生的血糖异常状态。这类被称为糖尿病前期的情况，其特征在于空腹血糖、口服葡萄糖耐量试验时的血糖水平，或糖化血红蛋白值介于“正常”值与糖尿病特征值之间。从流行病学角度定义，最后这些情况与微血管疾病（主要是视网膜病变）的较高发病率相关。糖尿病前期与“代谢综合征”的组成部分重叠，其中包括内脏脂肪过多、高血压、高甘油三酯血症、高水平的小而密低密度脂蛋白以及代谢相关脂肪性肝病。毫无疑问，糖尿病前期具有重要的预后意义，尤其是对心肌梗死、缺血性中风和外周动脉疾病的发生而言。然而，除了构成糖尿病前期的危险因素外，糖尿病前期本身是否是一个可采取行动的疾病实体存在争议。由于这种不确定性，欧洲心脏病学会最新指南选择不将糖尿病前期列为动脉粥样硬化性心血管疾病的治疗靶点，这与该指南此前的三个版本不同。这引发了一场辩论，本文的辩论文章中呈现了正反两方面的观点。
