Prädiabetes: differenzierte Betrachtung von Subtypen, Risiken und Pathomechanismen

Prediabetes is defined by blood glucose levels that are elevated but lower than diabetes thresholds. This condition can be detected by impaired fasting glucose, impaired glucose tolerance, or elevated HbA_1c (glycated hemoglobin). In Germany and the USA, prediabetes is particularly common among older adults. The risk of developing diabetes from prediabetes varies, but prediabetes is strongly associated with an increased risk of diabetes-related complications. The underlying pathophysiological processes include altered insulin sensitivity, insulin production and gluconeogenesis, which are influenced by genetic factors and fat compartment distribution. Six subphenotypes of prediabetic metabolism have been identified, accounting for pathophysiological differences and allowing more accurate risk assessment for the development of type 2 diabetes and its complications. This classification, based on extensive metabolic and genetic data, supports the development of personalized prevention and treatment strategies.