While pre-diabetes is a reversible condition, if neglected, it can lead to diabetes which has to be managed for all of one’s lifetime.
Pre-diabetes is a condition where the blood glucose levels are higher than normal but not high enough to be diagnosed as diabetes. It has also been described as borderline diabetes. Research has shown that in this pre-diabetic stage itself, thickenin g of the blood vessels (atherosclerosis) supplying certain vital organs in the body, particularly the cardiovascular system occurs. The good news is that, several studies have documented that people with pre-diabetes can prevent or post-pone the development of diabetes. This observation has prompted the healthcare providers to create public awareness about pre-diabetes.
Prevention or delay onset
Diabetes is one of the most expensive and burdensome chronic diseases and is increasing in epidemic proportions in India and throughout the world. Given these facts, it is a good augury that studies have been initiated in the last decade to determine the feasibility and benefit of various strategies to prevent or delay the onset of type 2 diabetes.
Should we attempt to prevent diabetes?
There are at least five conditions that should be met to justify initiating a programme to prevent a disease. Ideally, these criteria should be applied to the prevention of diabetes-related morbidity and mortality rather than merely the diagnosis of diabetes.
First, the disease to be prevented should be an important health problem that imposes a significant burden on the affected population. Without question, diabetes satisfies this criterion.
Second, the early development and natural history of the disease should be understood sufficiently well to identify parameters that measure its progression to disease. Here, we have a great deal of data showing that the incidence of diabetes is strongly related to the hyperglycemic states — Impaired fasting glucose (IFG ) and Impaired glucose tolerance test (IGT). Although there is evidence that other factors are independently associated with the development of diabetes, such as age, family history of diabetes, waist-to-hip ratio, body mass index (BMI), blood pressure, and lipid levels, none taken singly is as good at discriminating who will progress to diabetes as measuring glucose levels. It should be noted, however, that when taken in the aggregate, these risk factors combined with plasma glucose levels are more predictive of future diabetes than are glucose levels by themselves.
Third, there should be a test to detect the pre-disease state that is safe, acceptable, and predictive. Two tests meet this criterion: measurement of fasting plasma glucose (FPG) and the 2-h value in the oral glucose tolerance test (OGTT).
Fourth, there should be safe, effective, and reliable method(s) to prevent or at least delay the disease from occurring. The results of several prevention studies indicate that there are now interventions capable of at least delaying the onset of diabetes. It also had a beneficial effect on health in addition to diabetes prevention.
Fifth, the effort to find individuals who are at high risk of getting the disease and in this context, the cost of the intervention(s) should not be burdensome and should be cost-effective.
How should diabetes prevention be performed?
The strategies shown to be effective in preventing diabetes relies on lifestyle modification or glucose-lowering drugs that have been approved for treating diabetes.
Lifestyle modification: Diabetes could be delayed or prevented with merely modest changes in weight and physical activity. Pharmacological interventions: Several diabetes prevention trials used pharmacological therapy, such as metformin, acarbose and glitazone and have reported a significant lowering in the incidence of diabetes.
Lifestyle or medication?
The greater benefit of weight loss and physical activity strongly suggests that lifestyle modification should be the first choice. It also has other benefits such as improving cardiovascular health and quality of life.
If you are diagnosed with either IFG or IGT, consider yourself lucky as it is an early warning, a wake up call.
IFG and IGT are not clinical entities in their own right but rather predictors of future diabetes as well as cardiovascular disease. Note that many individuals with IGT have normal blood sugar in their daily lives. Individuals with IGT often manifest elevated blood glucose only when challenged with the oral glucose load used in the standardised OGTT. The detection and intervention of pre-diabetes is worthwhile as otherwise there will be a huge financial burden resulting from the complications of diabetes to the individual, family and exchequers.
While pre-diabetes is a reversible condition, if neglected, it can lead to Type 2 diabetes, which must be managed for one’s lifetime.
The good news is that several studies have documented that people with pre-diabetes can prevent or postpone the development of diabetes.
The writers are Chennai-based Consultant Diabetologists.
Frequently asked questions
Is pre-diabetes the same as Impaired Glucose Tolerance or Impaired Fasting Glucose?
Yes. Doctors sometimes refer to this state of elevated blood glucose levels as Impaired Glucose Tolerance or Impaired Fasting Glucose (IGT/IFG), depending on which test was used to detect it.
How do I know if I have pre-diabetes- IFG/ IGT?
For Understanding the Fasting Plasma Glucose [FPG] Test results, see Table 1 below.
For Understanding the Oral Glucose Tolerance Test [OGTT] results, see Table 2 below.
In the OGTT, a person’s blood glucose is measured after an overnight fast and two hours after drinking 75 g glucose-dissolved in water.
Poor reproducibility of IGT and IFG classification suggests caution should be exercised when interpreting a single test result.
Most laboratory reports have reference range for either normal values or for diabetes. When individuals attempt to interpret their results based on the laboratory reference range without consulting a doctor they may completely miss the diagnosis of pre-diabetes.
Who should get tested for pre-diabetes?
No study has explicitly addressed the age at which screening should begin and the optimal frequency of screening. If your weight is normal and you’re over 40, you should ask your doctor during a routine office visit if testing is appropriate. If you are overweight (especially around the abdomen) and aged above 30 - 35, you should be checked for pre-diabetes during your next routine medical office visit. For adults younger than 30 – 35 years and overweight, your doctor may recommend testing if you have any other risk factors for diabetes. These include high blood pressure, low HDL cholesterol and high triglycerides, leading a sedentary lifestyle, family history of diabetes, history of gestational diabetes or having given birth to a baby weighing more than 3.5 kg and history of Polycystic ovaries (PCOD).
Screening will not only detect cases of IFG or IGT, but also cases of undiagnosed diabetes.
How often should I be tested?
If your blood glucose levels are in the normal range, it is reasonable to get checked every two years. If you have pre-diabetes, you should be checked for type 2 diabetes every six months to one year after your diagnosis.
Why do I need to know if I have pre-diabetes?
For some people with pre-diabetes, intervening early can actually turn back the clock and return elevated blood glucose levels to the normal range.
What is the treatment for pre-diabetes?
Treatment consists of losing a modest amount of weight (5-10 per cent of total body weight) through diet and moderate exercise, such as walking, 30 minutes a day, five days a week. The activity can be split into several short periods: Three sessions of 10 minutes each. Choose an activity which you enjoy. The more weight lost, the better. Not to lose heart – even if you can’t get to your ideal body weight a loss of just 4-5 kg can make a huge difference.
Even for those within their recommended body weights, there is strong epidemiologic data suggesting that regular exercise will reduce overall risk of diabetes and other conditions.
It is recommended to follow a diet which includes healthy, wholesome foods, high in dietary fibre. Include more low Glycemic index (complex) carbohydrates and vegetables in your diet.
Your doctor may also wish to treat or counsel you about cardiovascular risk factors, such as tobacco use, high blood pressure, and high cholesterol.
Could I have pre-diabetes and not know it?
Absolutely. People with pre-diabetes don’t often have symptoms. In fact, millions of people have diabetes and don’t know it because symptoms develop so gradually, people often don’t recognise them.
What does pre-diabetes mean to me?
It will serve as a "wake-up call" to at-risk patients who previously may not have taken action to lower their risk. The hope is to trigger some effort on the part of individual. Some people in these circumstances will be jarred into action, while others will not. Our hope is that a significant number will. But failing to provide that information means that no one would.