Establishing a Third Category IFG Why and What is IFG

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The new category - Impaired Fasting Glycaemia - was introduced by the ADA expert committee in 1997. This was in many ways the logical consequence of their recommendation to stop using the OGTT, as this would make the diagnosis of IGT impossible. The hope was that through establishing the new category IFG it would be possible to identify a group comparable to the IGT with respect to risk of progression to diabetes and risk of developing CVD.

As already discussed, the DECODE-study showed that while IGT is associated with an increased risk of developing CVD this is only the case in IFG-individuals if they also have abnormal 2-h glucose values [11,13]. In other words, isolated IFG is not associated with increased risk of CVD or increased all cause mortality. It has also been shown that while IGT is often associated with other abnormalities associated with the metabolic syndrome as dyslipidemia and hypertension, this is not the case for isolated IFG (at least not to the same extent) [18].

The different phenotypes of individuals with IFG and IGT have led to the question whether these two conditions reflect the same underlying pathogenic mechanisms. An answer to this question is important, as several trials have shown that progression from IGT to diabetes can be prevented by life style intervention (diet and physical activity) [19-22]. These interventions are likely to exhibit their effects through increased insulin sensitivity and modifications in body composition. Consequently, the interventions are only likely to be effective in the case of insulin resistance as the underlying mechanism. If, however, IFG is more linked to beta-cell dysfunction than to insulin resistance (which would be in compliance with the relative absence of metabolic abnormalities in IFG-individuals), then life style intervention would be less likely to have an effect on this group of individuals. It should also be noted that IFG only identifies approximately 25-30% of all individuals with IGT in a given population. In conclusion it should therefore be noted that IFG and IGT are not the same conditions; they are not characterised by the same phenotypic abnormalities; and they are not associated with the same risk of progression to diabetes or risk of developing CVD. Therefore, the clinical relevance of IFG as a clinical category or risk group remains questionable.

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