Prediabetes

1st October 2021


Prediabetes is a condition in which blood glucose is higher but not high enough to diagnose it as diabetes. If a glucose tolerance test is done randomly in a large population, 1-2 % will be found to have unsuspected diabetes. A much larger 5% or more (depending on age, race, and nutritional level ) fall into an intermediate category called Prediabetes.

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There are two stages of dysglycemia. In impaired glucose tolerance ( IGT) or impaired glucose regulation, fasting plasma glucose level is between 110-125 mg /dl, and 2 hours post glucose load glucose value is between 140-199 mg/dl. Such people need careful follow-up because it may progress to frank diabetes. In Impaired fasting glucose (IFG) fasting glucose level is between 110-125 mg /dl (less than 7mmol/l) but the 2-hour glucose level is within normal limits (Less than 140).

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The Impaired Glucose Tolerance (IGT) and Impaired Fasting Glucose ( IFG) groups both are at risk of developing diabetes and cardiovascular disease in the future. They are sometimes jointly referred to as Prediabetic, but this term is avoided because the abnormality does not progress in the majority. Obesity and lack of regular physical exercise make progression more likely. Patients with prediabetes have a risk of cardiovascular disease twice that of normal, but they do not develop the specific microvascular complications of diabetes.

Causes for impaired glucose metabolism may be different such as obesity, liver diseases, or drugs.

Risk factors for having Prediabetes

  • Age more than 35 years
  • Family history of diabetes. In the first degree relatives ( parents and siblings)
  • Body mass index (BMI) of 25 kg/m2 or higher. Blood pressure, heart disease, strokes as well as diabetes risk increase with increasing BMI.
  • Waistline; 40 inches or more in men and 35 inches or more in women. (for the Asian population a BMI of 23kg/m2 and a waistline of 35 inches in men and 31 inches in women are considered)
  • Increase carbohydrates and a high caloric diet.
  • Smoking: Nicotine decreases the sensitivity of body cells to insulin
  • Increase alcohol consumption
  • Sedentary lifestyle
  • Race or ethnicity; more in native Americans, Africans, Asians, Latino, and Pacific Islanders.
  • History of gestational diabetes or delivery of baby more than 4kg (>9lb)
  • Polycystic Ovarian Syndrome
  • Acanthosis Nigricans

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General Guidelines

To prevent prediabetes from progressing to type 2 diabetes

Take Healthy Food

Take low fat and calories and a high fiber diet. Foods with a low glycemic index should be selected (e.g. whole grains, legumes, fruits, green leafy vegetables. Oats, yogurt, dairy products, tea and coffee, fish and seafood, nuts especially walnuts, apples, and red grapes are good to take) Intake of refined carbohydrates should be reduced. Reduced potion size.

Increase Physical Activity

Moderate-intensity aerobic exercise minimum of 30 minutes five days a week or if obese, 60-90 minutes 6-7 days a week to lose weight is recommended. Consult healthcare providers for a safe exercise program depending on your health condition.

Weight Reduction

There is a strong evidence that weight reduction improve insulin sensitivity, glycemic control, lipid profile and blood pressure in Type 2 diabetes and decrease the risk of developing diabetes in future.

A 5-10% weight loss may result in significant improvement in blood glucose control among patients with diabetes and may help prevent the onset of diabetes in patients with Prediabetes. Changes in lifestyle, dietary modification, and increased physical activity are necessary for weight reduction. Anti-obesity medications may be considered for patients who are not able to lose weight through lifestyle modifications but their long-term risks and benefits are unclear.

Bariatric surgery is indicated for patients with a BMI of 40 kg/m2 or more or 35 kg/m2 or more with other comorbidities ( decrease calculations 2.5kg/m2 less for Asians)

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Smoking

Smokers are 30 to 40 % more likely to develop type 2 diabetes than nonsmokers. Smoking can also make managing the disease and regulating insulin levels more difficult because high levels of nicotine can lessen the effectiveness of insulin, causing smokers to need more insulin to regulate blood sugar levels.

Medication

Sometimes Metformin is advised if the above measures are not working and medicine for the control of blood pressure or for cholesterol is usually advised.

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