Can 'personalized diagnostics' promote earlier intervention for dysglycaemia? Hypothesis ready for testing

The risk associated with progression to diabetes as well as for cardiovascular complications increases along a continuum, rather than being threshold-dependent. How can we identify those with glucose levels in the upper reaches of normal who are most in need of a preventive intervention? With present criteria, we are likely excluding many individuals who have heightened risk. We introduce here the possibility of using a "personalized" glucose profile to encourage early intervention in subjects in whom glucose metabolism is deteriorating (on an individual level) but not yet abnormal on a population-based norm. We further suggest that "personalized profiles" of hemoglobin A1c and basal plasma insulin may also help encourage appropriately early intervention. That the first line therapies are so effective, safe and simple make these more sensitive approaches very attractive. Copyright (C) 2010 John Wiley & Sons, Ltd.