title: Should the metabolic syndrome patient with prediabetes be offered pharmacotherapy?
abstract: Impaired fasting glucose and impaired glucose tolerance reflect perturbations in glucose metabolism and define a prediabetic state in which risk for type 2 diabetes mellitus (T2DM) is increased. There is overlap between prediabetes and the metabolic syndrome, which itself increases the risk for T2DM and cardiovascular disease. The utility of medical interventions to prevent progression to diabetes in prediabetic individuals, many of whom also manifest metabolic syndrome, has been examined in several large clinical trials. Intensive lifestyle intervention consistently results in drastic reductions in the incidence of T2DM and reversal of metabolic syndrome. Additionally, pharmacotherapies-including metformin, acarbose, thiazolidinediones, glucagon-like peptide 1 receptor agonists, and renin-angiotensin inhibitors-also reduce diabetes incidence with variable effects on metabolic syndrome components. Taken together, we recommend that prediabetic patients undergo intensive lifestyle intervention, with the addition of pharmacotherapy based on the presence of specific features of the metabolic syndrome, for diabetes prevention.
authors.affiliation: Department of Endocrinology, Washington Hospital Center, 110 Irving Street, NW, Suite 2A-72, Washington, DC 20010, USA. Shannon.d.sullivan@medstar.net
authors.forename: Shannon D
authors.initials: SD
authors.lastname: Sullivan
authors.forename: Robert E
authors.initials: RE
authors.lastname: Ratner
mesh_terms: D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000191:economics / Q000517:prevention & control; D018450:Disease Progression; D006801:Humans; D008019:Life Style; D024821:Metabolic Syndrome / Q000150:complications* / Q000188:drug therapy* / Q000453:epidemiology; D011236:Prediabetic State / Q000150:complications* / Q000188:drug therapy* / Q000453:epidemiology