Intervening Early in the Cardiovascular-Kidney-Metabolic Syndrome: Expert Recommendations from the United Arab Emirates on the Management of Prediabetes

The emerging concept of the cardiovascular-kidney-metabolic (CKM) syndrome encapsulates the interrelated nature of metabolic processes and metabolic dysfunction. Prediabetes, which describes the presence of elevations of blood glucose measurements insufficient to provoke a diagnosis of type 2 diabetes (T2D), is an important, – and crucially, reversible – early manifestation of the CKM syndrome. Numerous clinical studies and meta-analyses have shown that a substantial minority of people with prediabetes have microvascular and/or macrovascular complications reminiscent of those seen in clinical T2D. Prediabetes therefore represents an early stage of a continuum of increased insulin resistance, hyperglycaemia and associated vascular risk that begins at blood glucose concentrations that are well below those required for a diagnosis of diabetes. This condition also provides an opportunity for early intervention. All people with prediabetes should receive a multifactorial lifestyle intervention that focuses of weight management, nutrition, physical activity and smoking cessation. Where this is insufficient, ineffective or not followed, metformin remains the best studied pharmacotherapy for the management of prediabetes, with formal therapeutic indications for this purpose in many countries and support within international guidelines. Weight management is crucial for diabetes prevention, and weight loss during receipt of incretin agonist drugs is effective in diabetes prevention in populations with prediabetes, although consideration should be given to how long the treatment should be maintained and how the patient should be managed when it is ultimately withdrawn.