1–6.9 mmol/L), an OGTT may be considered as it may reveal DM. However, an OGTT with normal FPG values may reveal IGT or DM; furthermore, an early diagnosis of IGT could allow the introduction of measures, such as changes in lifestyle or in antiretroviral Sotrastaurin treatment, aimed at preventing progression to full-blown DM, and in turn an early diagnosis of DM could help to avoid the severe complications of the disease

[31,32]. Screening for pre-diabetes and type 2 DM in asymptomatic people should be considered in adults of any age who are overweight or obese (BMI≥25 kg/m2) and have one or more additional risk factors for diabetes [25]. HIV-infected patients have additional risks associated with drug treatment [2–10] that make them click here candidates for proactive screening. The OGTT revealed that 11% of our cohort of (predominantly male) Caucasian patients with long-standing HIV infection had IGT or DM, undiagnosed on the basis of

FPG levels; among the considered factors, only CD4 cell counts and HOMA-IR predicted abnormal glucose tolerance. No previous study has the same design as ours, and so our results cannot be directly compared with others. Type 2 DM is frequently not diagnosed until complications appear, and approximately one-third of all people with diabetes may be undiagnosed. Although the effectiveness of identifying pre-diabetes and diabetes early by means of the mass testing of asymptomatic individuals has not been conclusively demonstrated (and rigorous trials to provide such a conclusive demonstration are unlikely to be carried out), pre-diabetes and diabetes meet the established criteria new for conditions for which early detection is appropriate [25]. The presence of pre-diabetes or diabetes can be established on the basis of FPG levels or a 2-h OGTT (75-g glucose load) or both. The OGTT is more sensitive and slightly more specific for diagnosing diabetes, but FPG is currently recommended because

the OGTT is more difficult to perform in practice and the results are less reproducible; however, the OGTT may be useful for further evaluating patients in whom diabetes is still strongly suspected but who have normal or impaired FPG levels [25]. In HIV-infected patients, FPG levels may be relatively insensitive for detecting all cases of DM: one study found that 72% of men meeting the criteria for DM by the 75-g OGTT had nondiabetic FPG levels, which is why the OGTT is considered necessary in studies aiming to capture all cases of DM in this patient population [33]. The duration of glycaemia is a strong predictor of adverse outcomes, and there are effective means of preventing the progression of pre-diabetes to DM and reducing the risk of disease complications [25]. This may be particularly important in HIV-infected patients, who are at higher risk of cardiovascular diseases than the general population [16,17].