Overview
Abnormal glucose tolerance (AGT) encompasses conditions like prediabetes and impaired glucose tolerance, characterized by elevated blood glucose levels that do not meet the diagnostic criteria for diabetes but indicate an increased risk for developing diabetes and cardiovascular disease 12.Diagnosis
Oral Glucose Tolerance Test (OGTT): Essential for diagnosing AGT, categorizing it as "diabetes" or "borderline" based on criteria like those from the Japan Diabetes Society 2.
Fasting Plasma Glucose: Useful for initial screening 2.
HbA1c Measurement: Provides insight into long-term glucose control 2.
Insulinogenic Index: Determined during OGTT to assess beta-cell function 2.Management
Enhanced External Counterpulsation (EECP): May improve resistance artery function and glycemic control in individuals with AGT 1.
Cibenzoline: In patients with AGT and frequent ventricular arrhythmias, cibenzoline (150-300 mg/day) can significantly decrease fasting plasma glucose and HbA1c levels 2.Special Populations
Comorbidities: Patients with frequent ventricular arrhythmias may benefit from antiarrhythmic agents like cibenzoline, which also impacts glucose metabolism 2.Key Recommendations
Consider enhanced external counterpulsation therapy to improve arterial function and glycemic control in patients with abnormal glucose tolerance (Evidence: Moderate) 1.
Evaluate the use of cibenzoline in AGT patients with concomitant frequent ventricular arrhythmias, noting its potential hypoglycemic effects (Evidence: Weak) 2.
Regularly monitor HbA1c and perform OGTT to assess and manage glycemic control in individuals with abnormal glucose tolerance (Evidence: Expert opinion) 2.References
1 Martin JS, Beck DT, Braith RW. Peripheral resistance artery blood flow in subjects with abnormal glucose tolerance is improved following enhanced external counterpulsation therapy. Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme 2014. link
2 Saikawa T, Arita M, Yamaguchi K, Ito M. Hypoglycemic effect of cibenzoline in patients with abnormal glucose tolerance and frequent ventricular arrhythmias. Cardiovascular drugs and therapy 2000. link