Prevention and Treatment of Type 2 Diabetes: A Pathophysiological-Based Approach. (June 2018)

• Record Type: Journal Article
• Authors: Samocha-Bonet, Dorit; Debs, Sophie; Greenfield, Jerry R.
• Is Part Of: Trends in endocrinology and metabolism. Volume 29:Number 6(2018)
• Page Start: 370
• Page End: 379
• Publication Date: 2018-06
• Subjects: metformin -- prediabetes -- gut microbiomics -- metabolomics -- genomics -- personalized management; Endocrinology -- Periodicals; Metabolism -- Periodicals; Metabolism; 616.4
• DOI: 10.1016/j.tem.2018.03.014
• Languages: English
• ISSNs: 1043-2760

Abstract

Abstract : Prediabetes affects approximately 40% of American adults. Randomized trials report that a proportion of individuals with prediabetes develop diabetes despite caloric restriction, physical activity, and/or when treated with metformin, the first-line medication for patients with type 2 diabetes mellitus (T2DM). Currently, there are no valid predictors of the effectiveness of these measures in determining who will and who will not progress to the T2DM state. Few studies have examined the clinical and phenotypic predictors of better and worse glycemic response to lifestyle interventions and metformin in prediabetes and diabetes. Further studies incorporating 'omic' approaches to discover novel markers of phenotypes and treatment effectiveness may pave the way to personalizing the treatment of prediabetes and diabetes. Highlights: Prediabetes is common and is a significant risk factor for developing not only diabetes, but also micro- and macrovascular disease, fatty liver, and cancer. Prediabetes is characterized by heterogeneous defects in insulin sensitivity and insulin secretion, which are themselves determined by genetic and other factors. Many individuals with prediabetes progress to T2DM despite lifestyle intervention and treatment with metformin. Phenotypic predictors of better and worse responders to lifestyle interventions or metformin have been suggested, but findings are inconsistent.