Chronic Microvascular Complications in Prediabetic States-An Overview

Abstract

A prediabetic state is a major risk factor for the development of diabetes, and, because of an identical pathophysiological background of both conditions, their prevalence increases parallelly and equally fast. Long-term hyperglycemia is the main cause inducing chronic complications of diabetes, yet the range of glucose levels at which they start has not been yet unequivocally determined. The current data show that chronic microvascular complications of diabetes can be observed in patients with abnormal glucose metabolism in whom glycaemia is higher than optimal but below diagnostic criteria for diabetes. Prediabetes is a heterogenous nosological unit in which particular types are differently characterized and show different correlations with particular kinds of complications. Analysis of the latest research results shows the need to continue studies in a larger population and can imply the need to verify the currently employed criteria of diagnosing diabetes and chronic complications of diabetes in people with prediabetes.

Keywords: diabetes; microvascular complications; prediabetes.

Figure 1

Age-adjusted comparative prevalence of impaired glucose tolerance in adults (20–79 years) in 2019, adapted from International Diabetes Federation. IDF Diabetes Atlas, 9th edn. Brussels, Belgium [2].

Scheme 1

Fasting and 2-h post-load glucose, insulin sensitivity, and β-cell function trajectories before the diagnosis of diabetes, adapted from Tabák et al. [17].

Figure 2

Toxic pathways linking blood glucose levels to tissue damage in susceptible persons, adapted from Brannick et al. [3]; AGE, advanced glycosylation end products; eNOS, endothelial nitric oxide synthase; NF-κβ, nuclear factor-κβ; PAI-1, plasminogen activator inhibitor-1; PKC, protein kinase C; RAGE, receptor for AGE; TGF- β, transforming growth factor-β; UDP, uridine diphosphate; VEGF, vascular endothelial growth factor.