Pre-diabetes essential action: a European perspective.

Type 2 diabetes is a modern world-wide epidemic. Its complications are now a significant cause of morbidity and mortality in every European country and the consequences of its explosive growth are an intolerable burden both to the individual and to healthcare systems. The management of diabetes has become increasingly sophisticated over the past decade. Self management has been recognised and developed, there are now over a dozen pharmacological agents available to lower blood glucose (as well as blood pressure and dyslipidaemia), a multitude of ancillary supplies and equipment available, and there is a clear recognition by health care professionals and patients that diabetes is a serious disease. The normalization of blood glucose for any appreciable period of time, however, is seldom achieved. Even in well-controlled so-called “intensively” treated patients, serious complications still occur, and the economic and personal sequelae of diabetes remain [1-3]. Given these facts, it is not surprising that efforts have been initiated to determine the feasibility and benefit of various strategies to prevent or delay the onset of type 2 diabetes. Much of that effort has focused on what is now called “Pre-diabetes”. Already, a more accurate definition and intense study of pre-diabetes has led to some important insights: • Pre-diabetes is extremely common (as many as 40% of 40-74 year olds) [4] and needs to be addressed in clinical practice. • People with pre-diabetes are at high risk of developing diabetes and cardiovascular disease (CVD) and are the ideal target population for prevention programs. • There are safe, potentially effective interventions, which can affect modifiable risk factors. • Intensive lifestyle interventions are efficacious and should be encouraged but they may be difficult to broadly apply and sustain. • Effective pharmacological therapies have been identified to use in combination with these lifestyle interventions. The enormous impact of diabetes on public health, and the impressive progress made recently in understanding and treating pre-diabetes have encouraged the production of this paper. Managing pre-diabetes is the most cost effective way to avoid the many sequelae of diabetes and importantly the cardiovascular disease that comes with it. If left untreated most of these individuals will go on to develop type 2 diabetes within 10 years and a high proportion of them will suffer from microor macrovascular disease [5-7]. A group of European physicians, a diabetes specialist nurse, and patient representatives has reviewed key issues about the nature, identification and management of prediabetes in the Europe. They have agreed the available evidence for each question (reviewed here) and where no data is available a consensus of opinion has been provided.