Impaired glucose tolerance as a disease

Current criteria for diagnosing diabetes, based on fasting plasma glucose l evels during administration of the oral glucose tolerance test (OGTT), are poorly sensitive and are only modestly predictive of microvascular risk. Th e period after administration of OGTT is far more predictive and more close ly resembles the postprandial state where microvascular risk is elevated. H owever, persons who do not yet exhibit symptoms of diabetes may nonetheless have impaired glucose tolerance or dysglycemia, whereby macrovascular dise ase can develop at a glucose level lower than the threshold for microvascul ar disease and can progress in a graded fashion. This article reviews the f actors that may cause dysglycemia (including insulin resistance and obesity ) and how diet, blood pressure control, and the use of statins or glycemic/ insulin sensitizing may reduce cardiovascular risk in this prediabetic popu lation. (C) 2001 by Excerpta Medica, Inc.