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In prediabetes, blood sugar levels are higher than normal yet still below the threshold for diagnosis of diabetes, and recent studies indicate an increased risk of cardiovascular disease associated with this condition. This section deals with the latest scientific and clinical findings relating to prediabetes, including studies on the prevention of conversion from prediabetes to type 2 diabetes.

Presentations listing

CVD in 'Prediabetes': The Hoorn Study Experience - Prof. Robert J. Heine
The Metabolic Phenotype of Pre-diabetes in Obese Youth - Dr. Sonia Caprio
Impaired Glucose Tolerance versus Impaired Fasting Glucose:... - Prof. Markolf Hanefeld
Epidemiology of 'Prediabetes' and the MS - Global View - Prof. Jonathan Shaw
IFG and IGT - State of the Art - Dr. Nigel Unwin
Prediction of Type 2 Diabetes (T2DM) using alternative... - Dr. Ken Williams
Pre-diabetes: Definition - Dr. Sir George Alberti
"Prediabetes" - A Global Snapshot - Prof. Paul Zimmet
Beta-cell Dysfunction in Pre-Diabetes - Dr. Christian Weyer

"CVD in 'Prediabetes': The Hoorn Study Experience"

Prof. Robert J. Heine (biography)
English - 2005-04-15 - 23 minutes
(20 slides)

Summary :
Various definitions of the metabolic syndrome are applied. Their value to assess cardiovascular disease (CVD) risk is unclear. We compared the definitions proposed by the Adult Treatment Panel III (ATP3), World Health Organisation (WHO), European Group for the study of Insulin Resistance (EGIR), and American College of Endocrinology (ACE) with respect to the prevalence of the metabolic syndrome...

Learning objectives :
After viewing this presentation the participant will be able to discuss results from the Hoorn Study:

- Metabolic syndrome (different definitions) and CVD risk
- Metabolic syndrome and incident diabetes
- The predictive value of the metabolic syndrome compared to the sum of its components



"The Metabolic Phenotype of Pre-diabetes in Obese Youth"

Dr. Sonia Caprio (biography)
English - 2005-04-14 - 39 minutes
(44 slides)

Summary :
The unabated rise in the prevalence of childhood obesity has been accompanied by the appearance of a new pediatric disease: Type 2 diabetes. In adults, type 2 diabetes develops over a long period. Most, if not all, patients initially have impaired glucose tolerance (IGT), which is highly predictive of diabetes and cardiovascular disease. Little is known about IGT in pediatrics.


Learning objectives :
After viewing this presentation, participants will be able to discuss:
• The epidemiology of childhood obesity
• The emerging epidemic of type-2 diabetes in the world
• How the metabolic syndrome in adolescents was defined by Weiss et al (NEJM, 2004)
• Prevalence of impaired glucose tolerance and the metabolic syndrome in obese youth
• Mechanisms of insulin resistance in obese adolescents with impaired glucose tolerance
• The natural history of “pre-diabetes” in the young

Bibliographic references :
Sinha R, Fisch G, Teague B, Tamborlane WV, Banyas B, Allen K, Savoye M, Rieger V, Taksali S, Barbetta G, Sherwin RS, Caprio S. Prevalence of impaired glucose tolerance among children and adolescents with marked obesity. N Engl J Med. 2002 Mar 14;346(11):802-10.

Weiss R, Dziura J, Burgert TS, Tamborlane WV, Taksali SE, Yeckel CW, Allen K, Lopes M, Savoye M, Morrison J, Sherwin RS, Caprio S. Obesity and the metabolic syndrome in children and adolescents. N Engl J Med. 2004 Jun 3;350(23):2362-74.

Weiss R, Taksali SE, Tamborlane WV, Burgert TS, Savoye M, Caprio S. Predictors of changes in glucose tolerance status in obese youth. Diabetes Care. 2005 Apr;28(4):902-9.

Weiss R, Dufour S, Taksali SE, Tamborlane WV, Petersen KF, Bonadonna RC, Boselli L, Barbetta G, Allen K, Rife F, Savoye M, Dziura J, Sherwin R, Shulman GI, Caprio S. Prediabetes in obese youth: a syndrome of impaired glucose tolerance, severe insulin resistance, and altered myocellular and abdominal fat partitioning. Lancet. 2003 Sep 20;362(9388):951-7.



"Impaired Glucose Tolerance versus Impaired Fasting Glucose: Is the Risk the Same?"

Prof. Markolf Hanefeld (biography)
English - 2005-04-14 - 29 minutes
(26 slides)

Summary :
IGT and IFG are two risk categories for type 2 diabetes. According to the NCEPIII definition fasting hyperglycemia but not postchallenge hyperglycemia is considered as a single trait of the metabolic syndrome. As consistently shown IFG and IGT bear a similar risk for subsequent conversion to type 2 diabetes. They are, however, different in underlying pathophysiology: IFG is more related to...

Learning objectives :
After viewing this presentation the participant will be able to discuss:

- Differences in demographic epidemiology between IFG and IGT
- Differences in underlying pathophysiology between IFG and IGT
- IFG- and IGT-associated risk for diabetes
- Differences in the risk of CVD with IFG or IGT

Bibliographic references :
Markolf Hanefeld, MD, PHD, Carsta Koehler, PHD, Katja Fuecker, DIPL CHEM, Elena Henkel, MD, Frank Schaper, MD and Theodora Temelkova-Kurktschiev, MD, PHD. Insulin Secretion and Insulin Sensitivity Pattern Is Different in Isolated Impaired Glucose Tolerance and Impaired Fasting Glucose - The Risk Factor in Impaired Glucose Tolerance for Atherosclerosis and Diabetes Study Diabetes Care 26:868-874, 2003.

Kohler C, Temelkova-Kurktschiev T, Schaper F, Fucker K, Hanefeld M.
[Prevalence of newly diagnosed type 2 diabetes, impaired glucose tolerance and abnormal fasting glucose in a high risk population. Data from the RIAD study using new diagnostic criteria for diabetes]Dtsch Med Wochenschr. 1999 Sep 17;124(37):1057-61.

TS Temelkova-Kurktschiev, C Koehler, E Henkel, W Leonhardt, K Fuecker and M Hanefeld. Postchallenge plasma glucose and glycemic spikes are more strongly associated with atherosclerosis than fasting glucose or HbA1c levelDiabetes Care. 2000;23(12):1830-1834.



"Epidemiology of 'Prediabetes' and the MS - Global View"

Prof. Jonathan Shaw (biography)
English - 2005-04-14 - 34 minutes
(27 slides)

Summary :
The metabolic syndrome, diabetes and pre-diabetes have become major public health problems in recent decades, and are increasing in prevalence around the world. Declining levels of physical activity, increasing caloric intake and the subsequent rises in obesity rates have been documented in populations from virtually every ethnic and cultural background. Whilst pre-diabetes is more common in most...

Learning objectives :
After viewing this presentation the participant will be able to discuss:

- Prevalence of pre diabetes worldwide
- Prevalence of the metabolic syndrome in consequence of the definition used
- The need to develop a uniform method of determining obesity criteria that is ethnic specific



"IFG and IGT - State of the Art"

Dr. Nigel Unwin (biography)
English - 2005-04-14 - 32 minutes
(25 slides)

Summary :
Impaired glucose tolerance (IGT) and impaired fasting glycaemia (IFG) represent higher than normal blood glucose levels, based on post glucose challenge and fasting blood measurement respectively, and are associated with a markedly increased risk of developing diabetes and an increased risk of cardiovascular disease. Interest in these categories has grown with the clear demonstration that...

Learning objectives :
After viewing this presentation the participant will be able to discuss:

- Epidemiology of IFG and IGT
- Metabolic characteristics and CV risk factors associated with IFG and IGT
- Risk of diabetes and CVD mortality associated with IFG and IGT
- ADA proposal to lower the cut point for IFG

Bibliographic references :
M Coutinho, HC Gerstein, Y Wang and S Yusuf. The relationship between glucose and incident cardiovascular events. A metaregression analysis of published data from 20 studies of 95,783 individuals followed for 12.4 yearsDiabetes Care. 1999;22(2):233-240.

Andreas Festa, Ralph D’Agostino, Jr., Anthony J.G. Hanley, Andrew J. Karter, Mohammed F. Saad, and Steven M. Haffner. Differences in Insulin Resistance in Nondiabetic Subjects With Isolated Impaired Glucose Tolerance or Isolated Impaired Fasting Glucose Diabetes 53:1549-1555, 2004.

The DECODE Study Group Age- and Sex-Specific Prevalences of Diabetes and Impaired Glucose Regulation in 13 European CohortsDiabetes Care 26:61-69, 2003.

N. Unwin, J. Shaw, P. Zimmet and K. G. M. M. Alberti. Impaired glucose tolerance and impaired fasting glycaemia: the current status on definition and intervention Diabetic Medicine. Volume 19 Issue 9 Page 708 - September 2002.



"Prediction of Type 2 Diabetes (T2DM) using alternative definitions of Prediabetes"

Dr. Ken Williams (biography)
English - 2005-04-14 - 22 minutes
(12 slides)

Summary :
Impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) are commonly used to identify "PreDiabetic" individuals at high risk of developing T2DM. IGT is a simple and strong predictor but requires an unpopular oral glucose tolerance test (OGTT). We compared how well IGT and IFG predict T2DM relative to dichotomized versions of 4 alternative models using common clinical measurements: a...

Learning objectives :
After viewing this presentation, participants will be able to discuss:
- compare and contrast various prediabetes definitions;
- The decision Tree model as a prediabetes definition;
- Sensitivity and false positive rate of various prediabetes definitions in predicting type 2 diabetes.

Bibliographic references :
Report of the Expert Committee on the Diagnosis and Classification of Diabetes MellitusDiabetes Care 20: 1183-1197.

The Expert Committee on the Diagnosis and Classification of Diabetes MellitusReport of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus Diabetes Care 26:S5-S20, 2003

Kahn HS, Valdez R.Metabolic risks identified by the combination of enlarged waist and elevated triacylglycerol concentrationAm J Clin Nutr. 2003 Nov;78(5):928-34.



"Pre-diabetes: Definition"

Dr. Sir George Alberti (biography)
English - 2005-04-14 - 34 minutes
(22 slides)

Summary :
Prediabetes is an old term first used officially by WHO as a retrospective diagnosis to describe the state of a person which preceded the diagnosis of diabetes in that person. A radical new definition was introduced in the United States recently to describe collectively people found to have IGT and/or IFG. In other words it describes those with a high risk of developing diabetes in the future and...

Learning objectives :
After viewing this presentation the participant will be able to discuss:

- The changing definition of "prediabetes" according to a historical perspective
- Limitations of the current definition of “prediabetes”

Bibliographic references :
JACKSON WP;That expression, "prediabetes". Diabetes. 1962 Jul-Aug;11:334.

Keen H, Jarrett RJ, McCartney P.; The ten-year follow-up of the Bedford survey (1962-1972): glucose tolerance and diabetes. Diabetologia. 1982 Feb;22(2):73-8.



""Prediabetes" - A Global Snapshot"

Prof. Paul Zimmet (biography)
English - 2005-04-14 - 28 minutes
(41 slides)

Summary :
The dramatic increase in the prevalence of diabetes (mainly type 2) world-wide is a matter of enormous concern to public health authorities in both developed and developing nations and international agencies such as WHO. Perhaps of even greater concern is the simultaneous dramatic increase in numbers with IFG and IGT (prediabetes). This is occurring not only in adults but, in so far poorly...

Learning objectives :
After viewing this presentation the participant will be able to discuss:

- Prevalence rates of prediabetes in different populations around the world
- Gender differences in abnormal glucose tolerance
- IGT and IFG as CVD risk factors
- Progression to diabetes

Bibliographic references :
Davies MJ, Raymond NT, Day JL, Hales CN, Burden AC. Impaired glucose tolerance and fasting hyperglycaemia have different characteristics.Diabet Med. 2000 Jun;17(6):433-40.

F de Vegt, JM Dekker, CD Stehouwer, G Nijpels, LM Bouter and RJ Heine. Similar 9-year mortality risks and reproducibility for the World Health Organization and American Diabetes Association glucose tolerance categories: the Hoorn StudyDiabetes Care. 2000;23(1):40-44.

SB Harris, J Gittelsohn, A Hanley, A Barnie, TM Wolever, J Gao, A Logan and B Zinman. The prevalence of NIDDM and associated risk factors in native CanadiansDiabetes Care. 1997; 20(2):185-187.

M Tominaga, H Eguchi, H Manaka, K Igarashi, T Kato and A Sekikawa.
Impaired glucose tolerance is a risk factor for cardiovascular disease, but not impaired fasting glucose. The Funagata Diabetes StudyDiabetes Care. 1999; 22(6):920-924.



"Beta-cell Dysfunction in Pre-Diabetes"

Dr. Christian Weyer (biography)
English - 2004-06-04 - 51 minutes
(32 slides)

Summary :
In this presentation Dr. Weyer presents data from cross-sectional, prospective and longitudinal studies showing the importance of beta-cell dysfunction in the pathogenesis of type 2 diabetes.

Different kinds of stimuli act on the pancreatic beta cells, which secrete insulin, pro-insulin, C-peptide and amylin, which is a gluco-regulatory hormone. The profile of amylin secretion by...

Learning objectives :
After viewing this presentation the partcipant will be able to discuss:

- Differences in acute insulin response to glucose (AIR) and insulin sensitivity (M) between groups at high risk for type 2 diabetes
- Other hormonal abnormalities found in the pre-diabetic state
- The value of low AIR, low M and fasting hyperinsulinemia in predicting the risk of type 2 diabetes

Bibliographic references :
1. Weyer C, Maggs DG, Young AA, Kolterman OG.Amylin replacement with pramlintide as an adjunct to insulin therapy in type 1 and type 2 diabetes mellitus: a physiological approach toward improved metabolic control.
Curr Pharm Des. 2001 Sep;7(14):1353-73.

2. Negar G. Knowles, MA, Melinda A. Landchild, MA, Wilfred Y. Fujimoto, MD and Steven E. Kahn, MB, CHB.Insulin and Amylin Release Are Both Diminished in First-Degree Relatives of Subjects With Type 2 Diabetes Diabetes Care.2002;25:292-297.

3. Pratley RE, Weyer C.The role of impaired early insulin secretion in the pathogenesis of Type II diabetes mellitus.Diabetologia. 2001 Aug;44(8):929-45.

4. Weyer, Christian MD; Pratley, Richard E. MD; Tataranni, P. Antonio MD.Role of insulin resistance and insulin secretory dysfunction in the pathogenesis of type 2 diabetes mellitus: lessons from cross-sectional, prospective, and longitudinal studies in Pima Indians.Current Opinion in Endocrinology & Diabetes. 9(2):130-138, April 2002.

5. Kahn SE.The relative contributions of insulin resistance and beta-cell dysfunction to the pathophysiology of Type 2 diabetes.
Diabetologia. 2003 Jan;46(1):3-19.

6. Mai-Britt Toft-Nielsen, Mette B. Damholt, Sten Madsbad, Linda M. Hilsted, Thomas E. Hughes, Birgitte K. Michelsen and Jens J. Holst.Determinants of the Impaired Secretion of Glucagon-Like Peptide-1 in Type 2 Diabetic Patients JCEM.2001;Vol. 86, No. 8 3717-3723.

7. Christian Weyer, MD, P. Antonio Tataranni, MD, Clifton Bogardus, MD and Richard E. Pratley, MD.Insulin Resistance and Insulin Secretory Dysfunction Are Independent Predictors of Worsening of Glucose Tolerance During Each Stage of Type 2 Diabetes Development Diabetes Care 24:89-94, 2001.

8. C Weyer, RL Hanson, PA Tataranni, C Bogardus and RE Pratley.A high fasting plasma insulin concentration predicts type 2 diabetes independent of insulin resistance: evidence for a pathogenic role of relative hyperinsulinemiaDiabetes.2000; Vol 49, Issue 12 2094-2101.

9. Larsson H, Ahren B.Glucose intolerance is predicted by low insulin secretion and high glucagon secretion: outcome of a prospective study in postmenopausal Caucasian women.Diabetologia. 2000 Feb;43(2):194-202.

10. Christian Weyer, Clifton Bogardus, David M. Mott and Richard E. Pratley.The natural history of insulin secretory dysfunction and insulin resistance in the pathogenesis of type 2 diabetes mellitus J Clin Invest, September 1999, Volume 104, Number 6, 787-794.

11. Weyer C, Hanson K, Bogardus C, Pratley RE.Long-term changes in insulin action and insulin secretion associated with gain, loss, regain and maintenance of body weight.Diabetologia. 2000 Jan;43(1):36-46.

12. Eftihia V. Polyzogopoulou, Fotios Kalfarentzos, Apostolos G. Vagenakis, and Theodore K. Alexandrides. Restoration of Euglycemia and Normal Acute Insulin Response to Glucose in Obese Subjects With Type 2 Diabetes Following Bariatric Surgery Diabetes 52:1098-1103, 2003.


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