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Pre-diabetes and cardiovascular risk: detonating the time bomb

02 May 2020
9 min read
Volume 31 · Issue 5

Abstract

Pre-diabetes carries a cardiovascular risk. Beverley Bostock-Cox considers the interventions that can improve this risk in people with pre-diabetes

Pre-diabetes is a state of impaired glucose regulation where the body moves from normal levels of blood glucose to a position where increasing levels of insulin resistance result in higher and harmful sugar levels in the bloodstream. As its name suggests, it is a precursor of type 2 diabetes. Cardiovascular risk is also likely to be higher, mainly because of the links between hyperglycaemia and other known cardiovascular risk factors such as hypertension and dyslipidaemia. In people with pre-diabetes, the aim should be to treat all the modifiable risk factors through lifestyle interventions, especially by encouraging weight loss and increasing physical activity levels. Pharmacological interventions can be considered in addition to lifestyle change.

Type 1 diabetes is an autoimmune condition which tends to present acutely, with a swift and catastrophic loss of beta cell function in the pancreas leading to significant hyperglycaemia and, in some cases, potentially life threatening ketoacidosis (Diabetes UK, 2020). There is still a lack of clarity about why people develop type 1 diabetes, and as yet, prevention is not possible. In contrast, type 2 diabetes has a more gradual onset, with research showing that people often move through a process of normal insulin and glycaemic levels, to insulin resistance and hyperinsulinaemia, through to pre-diabetes and then to diabetes, with the potential to develop vascular complications (Stehouwer, 2018). At each stage there is the potential to halt, or at least slow down, the process and improve outcomes, often through lifestyle changes (Dunkley et al, 2014; Sun et al, 2017).

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