A Systematic Approach to Treating Early Metabolic Disease and Prediabetes

Nicholas W Carris; Brian E Bunnell; Rahul Mhaskar; Christopher G DuCoin; Marilyn Stern

doi:10.1007/s13300-023-01455-9

A Systematic Approach to Treating Early Metabolic Disease and Prediabetes

Diabetes Ther. 2023 Oct;14(10):1595-1607. doi: 10.1007/s13300-023-01455-9. Epub 2023 Aug 5.

Authors

Nicholas W Carris¹, Brian E Bunnell², Rahul Mhaskar³, Christopher G DuCoin⁴, Marilyn Stern⁵

Affiliations

¹ Department of Pharmacotherapeutics and Clinical Research, Taneja College of Pharmacy, University of South Florida, 12901 Bruce B. Downs Blvd MDC 30, Tampa, FL, 33612, USA. carris@usf.edu.
² Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
³ Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
⁴ Department of Surgery, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
⁵ Department of Child and Family Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, USA.

Abstract

At least 70% of US adults have metabolic disease. However, less is done to address early disease (e.g., overweight, obesity, prediabetes) versus advanced disease (e.g., type 2 diabetes mellitus, coronary artery disease). Given the burden of advanced metabolic disease and the burgeoning pandemics of obesity and prediabetes a systematic response is required. To accomplish this, we offer several recommendations: (A) Patients with overweight, obesity, and/or prediabetes must be consistently diagnosed with these conditions in medical records to enable population health initiatives. (B) Patients with early metabolic disease should be offered in-person or virtual lifestyle interventions commensurate with the findings of the Diabetes Prevention Program. (C) Patients unable to participate in or otherwise failing lifestyle intervention must be screened to assess if they require pharmacotherapy. (D) Patients not indicated for, refusing, or failing pharmacotherapy must be screened to assess if they need bariatric surgery. (E) Regardless of treatment approach or lack of treatment, patients must be consistently screened for the progression of early metabolic disease to advanced disease to enable early control. Progression of metabolic disease from an overweight yet otherwise healthy person includes the development of prediabetes, obesity ± prediabetes, dyslipidemia, hypertension, type 2 diabetes, chronic kidney disease, coronary artery disease, and heart failure. Systematic approaches in health systems must be deployed with clear protocols and supported by streamlined technologies to manage their population's metabolic health from early through advanced metabolic disease. Additional research is needed to identify and validate optimal system-level interventions. Future research needs to identify strategies to roll out systematic interventions for the treatment of early metabolic disease and to improve the metabolic health among the progressively younger patients being impacted by obesity and diabetes.

Keywords: Diabetes; Obesity; Overweight; Population health; Prediabetes; Prevention.