ABSTRACT
The prevalence of prediabetes, a forerunner of diabetes is very high, and its conversion to diabetes is also more rapid among Asian Indians. Prediabetes also predisposes to the development of macrovascular and to a lesser extent of microvascular complications of diabetes. In a large community-based epidemiological study, the Indian Council of Medical Research–India Diabetes (ICMR–INDIAB), data reported an overall prevalence of prediabetes of 10.3%, derived from 15 Indian states. This shows that the diabetes epidemic is far from over as many of them may soon convert to diabetes. Prediabetes, however, should not be considered a path to diabetes rather it should be a window of opportunity for the prevention of diabetes. This early screening, detection, and treatment of prediabetes should be made a national priority. Several countries have introduced lifestyle programs to prevent diabetes and, when indicated, pharmacological intervention with metformin as well. This consensus statement outlines the approaches to screening and lifestyle and pharmacological management of prediabetes in Asian Indians.
ABSTRACT
Sodium-glucose cotransporter 2 (SGLT2) inhibitors have varied metabolic effects beyond increasing glycosuria. This consensus review examines the role of dapagliflozin in health promotion, particularly its benefits in patients with and without type 2 diabetes mellitus (T2DM) and in cardiorenal rehabilitation post-coronavirus disease 2019 (COVID-19). Consensus recommendations were developed by subject experts in Endocrinology and Diabetology based on the online meeting held on 27 June 2020 to review the available evidence related to the role of SGLT2 inhibitors, with a focus on cardiovascular and renal metabolic therapy. Evidence suggests that dapagliflozin has a direct role in improving clinical outcomes in patients with chronic kidney disease (CKD) or heart failure (HF). These benefits of dapagliflozin were independent of reduction in blood pressure, glycemic control and weight, and also extend to patients without diabetes. The use of dapagliflozin in metabolic syndrome was endorsed by the majority of the experts; however, this would be off-label. It was opined that the role of dapagliflozin would currently be limited to treating T2DM with a focus on preventing HF or kidney disease progression. The need for conducting multidisciplinary academic meetings to have a balanced approach regarding the use of dapagliflozin among nondiabetic patients and the need for detailed evaluation of the role of SGLT2 inhibitors in vasculometabolic and cardiorenal rehabilitation post-COVID was also suggested.