The day a person is diagnosed with Type 2 diabetes is not the day the disease actually begins. There is a long general symptom-free period prior to that. So pre-diabetes quite simply means a slightly high glucose level which increases one’s risk of becoming diabetic in the future. If intervened at the right time, diabetes can be prevented or delayed.
Look at pre-diabetes as a window of opportunity. Compare it to you travelling beyond the speed limit on the wrong lane and you see a signboard that reminds you of your precious life and you immediately decide to change lanes to the right one and begin driving at the correct speed. Remember, the earlier you switch the better. But it’s never too late.
The use of a test called EZ scan can determine one’s risk. It’s a non-invasive test which evaluates the sweat flow to the hands and feet. It is understood that a large number of patients have an impairment in the flow many years before the onset of diabetes.
Why are we seeing such high numbers of pre-diabetics?
As per the Oman national registry in 2014 there was an estimated 33% pre-diabetics. There are a variety of risk factors which increases one’s chance which includes an age more than 45 years, a strong family history, ethnicity, sedentary lifestyle, smoking, unhealthy eating and obesity out of which obesity has the strongest risk. It is also probably due to a greater degree of awareness and screening programmes that we are able to identify patients a large numbers of patients earlier. Presently, India has the largest number of pre-diabetics (36.5 million) which is projected to increase to 63.6 million by 2040.
Who should be screened for pre-diabetes?
Any individual with the above mentioned risk factors or diagnosed with hypertension, high cholesterol levels will need to be screened. Women with a past history of diabetes in pregnancy will benefit from testing as well. If the tests are normal, repeat screening at three year intervals.
What is the risk of a person with pre-diabetes to develop diabetes later?
Prediabetes confers a 6 fold increased risk of diabetes compared to normal glucose levels. Elaborating further on the tests used, the higher the number of tests that are positive the higher the risk. The post glucose test is a better marker of risk than fasting test. The closer the Hba1c is to the upper range limit the higher the risk. A patient with a Hba1c of 5-5.4% has a 5.4% risk of developing diabetes in the next 5-6 years whereas the risk increases to 25-50% with a Hba1c in the range of 6-6.5%.
Why are we worried about pre-diabetes?
To begin with, I would request you to view diabetes as a condition beyond the numbers we know. One should remember that the cut-offs for diagnosing diabetes and the glycemic targets for patients on treatment are based on large scale population studies. Diabetes is strongly associated with multiple complications involving the heart, kidney, eye, nerves, blood vessels, and conjugal life. Evidence points to the fact that these complications are seen even in pre-diabetics. So remember, the risk of complications increase ‘sharply’ at the cut-offs we know but the risk extends into the prediabetic range as well. It’s a ‘graded’ risk. So it makes sense to intervene early and try to normalise glucose levels and prevent diabetes and its complications.
How can we prevent diabetes?
• Lose 7% of your body weight.
• Increase your physical activity to at least 150 minutes in a week.
• Adopt healthy eating. Get a customised diet plan from a registered dietician based on your existing weight and daily physical requirements.
• Quit using tobacco in any form.
• Give your body adequate rest.
Sleep for at least 7 hours at night.
What are the other therapeutic options?
If one doesn’t get closer to the targets after a period of lifestyle, medications can be considered. Medications can be considered earlier if the Hba1c is in the higher end of the range, if the BMI is >35, in patients lesser than 60 years and in women with a history of diabetes in pregnancy. The role of bariatric surgery to reduce weight and prevent diabetes is being studied in great detail.
To summarise, get yourself and your family members screened for pre-diabetes if you have one of the risk factors. Knowing about one’s health and taking action early is the key here. Lifestyle interventions have shown to be very effective in preventing diabetes. The earlier we change lanes, the better it is. Let us work together for a healthy future.
What are the glucose values that denote prediabetes?
FASTING GLUCOSE 2 HOUR (POST GLUCOSE) HBA1C (3 MONTH AVG VALUE GLUCOSE)
NORMAL <100 mg/dL < 140 mg/dL <5.7%
PRE-DIABETES 100-125 mg/dL 140-199 mg/dL 5.7-6.4%
DIABETES >126 mg/dL >200 mg/dL >6.5%
To convert mg to mmol divide by 18
Dr Praveen Jeyapathy is diabetologist at International Medical Centre – Apollo Sugar Clinic