Alessa Thamer, Al Awadi Fatheya, Al Kaabi Juma, Al Mamari Ali, Al Ozairi Ebaa, Alromaihi Dalal, Elhadd Tarik, Gunaid Abdallah A, Hassanein Mohamed, Jayyousi Amin A, Kalimat Raya, Brand Kerstin M G
Division of Endocrinology, Jaber Al-Ahmad Hospital, Kuwait City, Kuwait.
Endocrine Department, Dubai Hospital, Dubai Academic Health Corporation (DAHC), Dubai, United Arab Emirates.
Diabetes Metab Syndr Obes. 2024 Dec 17;17:4791-4802. doi: 10.2147/DMSO.S491591. eCollection 2024.
Prediabetes is the first stage of a continuum that extends through the diagnosis of clinical type 2 diabetes towards long-standing diabetes with multiple comorbidities. The diagnosis of prediabetes provides an opportunity to interrupt the diabetes continuum at an early stage to ensure long-term optimization of clinical outcomes. All people with prediabetes should receive intervention to improve their lifestyles (quality of diet and level of physical activity), as this has been proven beyond doubt to reduce substantially the risk of conversion to diabetes. Additionally, a large base of clinical evidence supports the use of metformin in preventing or delaying the transition from prediabetes to clinical type 2 diabetes, for some people with prediabetes. For many years, guidelines for the management of type 2 diabetes focused on lowering blood glucose, with metformin prescribed first for those without contraindications. More recently, guidelines have shifted towards prevention of diabetes complications as the primary goal, with increased use of GLP-1 receptor agonists (or multi-agonist incretin peptides) or SGLT-2 inhibitors for patients with existing atherosclerotic cardiovascular disease, heart failure or chronic kidney disease. Access to these medications often remains challenging. Metformin remains a suitable option for initial pharmacologic intervention to manage glycemia for many people with prediabetes or type 2 diabetes along with other therapy to maintain control of blood glucose or to address specific comorbidities as the patient progresses along the diabetes continuum.
糖尿病前期是一个连续过程的第一阶段，该过程贯穿临床2型糖尿病的诊断，直至发展为伴有多种合并症的长期糖尿病。糖尿病前期的诊断提供了一个在早期阶段中断糖尿病连续过程的机会，以确保临床结局的长期优化。所有糖尿病前期患者都应接受干预以改善其生活方式（饮食质量和身体活动水平），因为这已被确凿证明可大幅降低转化为糖尿病的风险。此外，大量临床证据支持对于一些糖尿病前期患者使用二甲双胍来预防或延缓从糖尿病前期转变为临床2型糖尿病。多年来，2型糖尿病管理指南侧重于降低血糖，对于无禁忌证的患者首先开具二甲双胍。最近，指南已转向以预防糖尿病并发症为主要目标，对于患有现有动脉粥样硬化性心血管疾病、心力衰竭或慢性肾脏病的患者，增加使用胰高血糖素样肽-1受体激动剂（或多激动剂肠促胰岛素肽）或钠-葡萄糖协同转运蛋白2抑制剂。获得这些药物往往仍然具有挑战性。对于许多糖尿病前期或2型糖尿病患者，二甲双胍仍然是初始药物干预以控制血糖的合适选择，同时结合其他疗法以维持血糖控制或随着患者在糖尿病连续过程中的进展处理特定合并症。
