糖尿病前期(Prediabetes)是指血糖指數高於正常值但未達到糖尿病(Diabetes Mellitus)的時期。目前許多關於糖尿病前期的研究發現,糖尿病前期會增加患者發展成爲第2型糖尿病、增加罹患心血管疾病和中風的危險。因此,現在已經有許多國家認定糖尿病前期需要納入正規治療。本文對糖尿病前期的定義、罹患糖尿病前期是否需要治療及治療方式的選擇和糖尿病前期與心血管疾病的相關性幾個方面進行探討,並對國人血糖餐前及餐後檢測的後續處理流程做初步的建議。所得結論爲:糖尿病前期包括葡萄糖耐受性不良(Impaired Glucose Glucose Tolerance, IGT)或/和空腹血糖異常(Impaired Fasting Glucose, IFG),有一些人同時存在兩種情況。IGT比IFG更能預測心血管疾病的風險。有關糖尿病前期的處理建議如下:(1)若空腹血糖到定結果爲100-109mg/dl者,應該進一步做風險評估和或OGTT。依據評估結果可區分爲DM、IGT、及葡萄糖耐量試驗正常,葡萄糖耐量正常者若合併有危險因素,至少每年應追蹤1次。(2)所有接受空腹血糖測定結果爲110-125mg/dl者,應該進一步做風險評估和OGTT。依據評估結果可區分爲DM、IGT、葡萄糖耐量試臉正常。葡萄糖耐量正常者若合併有危險因素,至少每年應追蹤1次。(3)所有接受餐後血糖測定結果140-199mg/dl者應該進一步做風險評估和OGTT。依據評估結果可區分爲DM、IGT、葡萄糖耐量試驗正常,分別接受進一步處理,葡萄糖耐量正常者若合併有危險因素,至少每年應追蹤1次。治療建議包括:改善生活模式和藥物治療。改善生活模式可以預防或延緩糖尿病的發生,是糖尿病前期首要建議治療方式,國外之臨床試驗結果也確認了降血糖藥物治療在糖尿病前期治療中有延緩糖尿病發生的好處,因此,藥物治療是改善生活模式之外的另一種選擇。
Prediabetes is a stage between normal and diabetes stage. Recent studies have found the potential risk of these populations in developing of future risk of type 2 diabetes, cardiovascular disease (CVD) and stroke. Therefore, many countries already calls their medical professionals to pay further attention in dealing with prediabetes rigorously. In this article, we had thoroughly reviewed the definition, clinical implications and its relations with CVD in prediabetes status. Preliminary consensus was presented on the clinical suggestions and processes in managing fasting as well as postmeal blood glucose. The conclusions are as follows: prediabetes includes impaired glucose tolerance (IGF) and /or impaired fasting glucose (IFG), and some patients have the two statuses at the same time; hazards of prediabetes include increasing the chances of type 2 diabetes and CVD. The consensus are (1) Risk management and/or OGTT and should be carried out if fasting glucose value between 100 to 109 mg/dl. (2) Risk management and OGTT and should be carried out if fasting glucose value between 110 to 125 mg/dl. (3) Risk management and OGTT and need to be perform if postprandial glucose value between 140 to 199 mg/dl. Mangement of prediabetes includes lifestyle modification and possible medications which have been shown to reduce chance of developing diabetes in large scale clinical trials.