Diabetes and pre-diabetes, a rapid test to diagnose them early

Diabetes and pre-diabetes, a rapid test to diagnose them early

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New diagnostic criteria to reach an earlier diagnosis of pre-diabetes or diabetes. A ‘quick’ test based on the mini-curve, i.e. the measurement of blood sugar in the first hour of the glucose load curve: above 155 mg/dl the diagnosis of ‘pre-diabetes’ is made; above 209 mg/dl of diabetes.

The International Diabetes Federation (IDF), which brings together over 240 national diabetology associations from over 161 nations, in a consensus document just published, proposes to introduce these new criteria for the diagnosis of pre-diabetes and diabetes. The contribution of Italian research to the introduction of these new criteria is decisive, much more sensitive than the previous ones, capable of intercepting subjects at risk of diabetes or already diabetics earlier and therefore treating them more promptly.

The ‘mini-curve’ allows you to make a very early diagnosis of diabetes and pre-diabetes, at least a couple of years earlier than current tests (traditional two-hour glucose load curve, or OGTT).

Towards a new definition of diabetes and prediabetes

The new Position Statement of the IDF has therefore adopted, after a careful review of all existing scientific literature, the threshold value of > 155 mg/dL in the first hour of the glucose load curve for the diagnosis of ‘pre-diabetes’ (intermediate hyperglycemia) in subjects with normal fasting glycemia; this value is highly predictive of progression towards type 2 diabetes, micro- and macro-vascular complications, sleep apnoea, hepatic steatosis (fatty liver) associated with metabolic dysfunction and mortality in subjects with risk factors.

A new diagnostic criterion for type 2 diabetes is also introduced, i.e. a blood sugar level above 209 mg/dl always in the first hour of the load curve. “The new diagnostic criteria at the first hour of the load curve – comments the professor Giorgio Sesti, Professor of Internal Medicine at the Sapienza University of Rome and president of the Society of Internal Medicine, SIMI – allow for the early identification of subjects at increased risk of diabetes or already diabetics, who escape this diagnosis with the current diagnostic criteria (fasting blood sugar < 100 mg/dl, blood sugar two hours after OGTT < 140 mg/dl, HbA1c < 5.7%). This means that it will be possible to formulate the diagnosis of diabetes and prediabetes through a 'mini-curve' of glucose load of just one hour (instead of the current two hours). But above all, it will allow us to intercept a series of subjects who current criteria do not allow us to identify as either pre-diabetics or diabetics. The 'mini-curve' represents a more practical and sensitive method to 'capture' a greater number of subjects at risk of developing frank diabetes and to recognize subjects with already established diabetes earlier."

In short, thanks to the adoption of these new diagnostic criteria, people will have the possibility of arriving at an earlier diagnosis of pre-diabetes or diabetes. “Diagnosing the risk of developing diabetes or diabetes itself earlier – explains Professor Sesti – allows a series of preventive measures regarding lifestyle or pharmacology to be implemented more promptly, which help prevent the progression towards frank diabetes and to contain the damage of diabetes. In fact, vascular complications are often already present at the time of diagnosis of diabetes.”

Prevent diabetes

It is possible to prevent the progression from pre-diabetes to diabetes by implementing a drastic change in lifestyle (balanced diet and weight loss if necessary, physical activity, fighting a sedentary lifestyle, taking care of sleep hygiene, stopping cigarette smoking ) and in some cases resorting to drug therapy. “The ‘mini-curve’ – underlines Professor Sesti – allows us to identify subjects with pre-diabetes who, with the diagnostic criteria currently in use, would have escaped diagnosis and therefore the implementation of effective prevention. Furthermore, longitudinal studies have shown that the rise in blood sugar at the first hour of the glucose load curve occurs earlier in the natural course of the diabetic disease, i.e. almost two years before the rise in blood sugar at the second hour”.

How the new criteria were arrived at

The IDF arrived at the consensus document on the new diagnostic criteria after examining the results of numerous international studies on the significance of glycaemia in the first hour of the load curve, to which Italian research has made a notable contribution. In particular, the Internal Medicine group of the ‘Magna Graecia’ University of Catanzaro and the Sant’Andrea-Sapienza University Hospital of Rome has published over 40 articles on the topic. Great uproar in the media and the international scientific community was caused in 2015 by the publication of a study on Journal of Clinical Endocrinology and Metabolism (JCEM, official organ of the American Endocrine Society), signed by the professor Giorgio Sesti and the teacher Teresa Vanessa Fiorentino, Associate of Internal Medicine at the ‘Magna Graecia’ University of Catanzaro, who demonstrated how glycaemia in the first hour of the glucose load curve was able to predict with good accuracy the risk of developing full-blown diabetes within the following 5 years, even in normoglycemic people, i.e. with normal fasting blood sugar. “The glycaemia in the first hour of the load curve – recalls Professor Sesti – has already been used for some time for the diagnosis of gestational diabetes, therefore it represents an important pathophysiological element, which has so far been neglected. In fact, early hyperglycaemia is already a marker of diabetes or of increased risk of disease. Therefore – concludes the president of SIMI – if it is true that the new diagnostic criteria of the IDF represent a ‘novelty’ in the diagnosis of diabetes, the importance of glycaemia in the first hour of the OGTT is already consolidated by time, from a physiopathological point of view”.

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