Modern-Day Management of the Dysglycemic Continuum: An Expert Viewpoint from the Arabian Gulf

Thamer Alessa,1 Fatheya Al Awadi,2 Juma Al Kaabi,3 Ali Al Mamari,4 Ebaa Al Ozairi,5 Dalal Alromaihi,6 Tarik Elhadd,7 Abdallah A Gunaid,8 Mohamed Hassanein,9 Amin A Jayyousi,10 Raya Kalimat,11 Kerstin MG Brand12 1Division of Endocrinology, Jaber Al-Ahmad Hospital, Kuwait City, Kuwait; 2Endocrine Department, Dubai Hospital, Dubai Academic Health Corporation (DAHC), Dubai, United Arab Emirates; 3Department of Internal Medicine, College of Medicine and Health Sciences, The United Arab Emirates University, Al-Ain, United Arab Emirates; 4Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman; 5Clinical Research Unit, Dasman Diabetes Institute, Dasman, Kuwait; 6Internal Medicine Department, Royal College of Surgeons in Ireland-Medical University of Bahrain, Adliya, Kingdom of Bahrain; 7Endocrine Section, Department of Medicine, Hamad Medical Corporation, Doha, Qatar; 8Internal Medicine, Sana’a University Faculty of Medicine, Sanaa, Yemen; 9Department of Endocrinology and Diabetes, Dubai Hospital, Dubai Academic Health Corporation (DAHC), Dubai, United Arab Emirates; 10Department of Endocrinology, Hamad Medical Corporation, Doha, Qatar; 11Medical Affairs, Merck Serono Middle East FZ-LLC, Dubai, United Arab Emirates; 12Global Research & Development Medical – MU CM&E, Merck Healthcare KGaA, Darmstadt, GermanyCorrespondence: Thamer Alessa, Division of Endocrinology, Jaber Al-Ahmad hospital, South Surra, Ministries Area, Kuwait City, 13060, Kuwait, Email [email protected]: Prediabetes is the first stage of a continuum that extends through the diagnosis of clinical type 2 diabetes towards long-standing diabetes with multiple comorbidities. The diagnosis of prediabetes provides an opportunity to interrupt the diabetes continuum at an early stage to ensure long-term optimization of clinical outcomes. All people with prediabetes should receive intervention to improve their lifestyles (quality of diet and level of physical activity), as this has been proven beyond doubt to reduce substantially the risk of conversion to diabetes. Additionally, a large base of clinical evidence supports the use of metformin in preventing or delaying the transition from prediabetes to clinical type 2 diabetes, for some people with prediabetes. For many years, guidelines for the management of type 2 diabetes focused on lowering blood glucose, with metformin prescribed first for those without contraindications. More recently, guidelines have shifted towards prevention of diabetes complications as the primary goal, with increased use of GLP-1 receptor agonists (or multi-agonist incretin peptides) or SGLT-2 inhibitors for patients with existing atherosclerotic cardiovascular disease, heart failure or chronic kidney disease. Access to these medications often remains challenging. Metformin remains a suitable option for initial pharmacologic intervention to manage glycemia for many people with prediabetes or type 2 diabetes along with other therapy to maintain control of blood glucose or to address specific comorbidities as the patient progresses along the diabetes continuum.Keywords: type 2 diabetes, prediabetes, diabetes continuum, metformin, antidiabetic therapy, diabetes complications