Diabetes and the metabolic syndrome--when is it best to intervene to prevent?

In addition to microvascular complications, patients with type 2 diabetes are at increased risk of cardiovascular disease (CVD) and mortality. An important initial step in reducing the overall burden of CVD, as well as other diabetes complications, is to prevent progression to diabetes in individuals at risk. A number of studies have indicated the increased presence of both established and emerging cardiovascular risk factors associated with the metabolic syndrome in individuals before the onset of diabetes. First-line therapy in the treatment of the metabolic syndrome risk factors is lifestyle intervention, which can be highly successful in preventing or delaying progression to overt diabetes, but on its own may not achieve and/or maintain adequate risk reduction. In this case, individuals need to be identified and treated with appropriate pharmacological interventions. The data are unequivocal in the importance of the timely identification of at-risk subjects, and implementation of effective treatment strategies, which could potentially reduce diabetes- and CVD-related morbidity and mortality.