Prediabetes

prediabetesPrediabetes is a condition where your blood glucose or A1c levels are higher than normal but not high enough for a diagnosis of diabetes.

People with prediabetes are at higher risk of developing type 2 diabetes and heart disease. The Centers of Disease Control and Prevention National Diabetes Statistics Report estimates that 37% of adults over the age 20 years and more than 50% of those older than 65 years had prediabetes in 2009-2012 which translates to about 86 million adults with prediabetes in United States.

The world wide prevalence of prediabetes in 2010 was estimated to be 343 million which is nearly 7.8% of the world population.

Symptoms of Prediabetes

You may not have any symptoms in prediabetes until you develop diabetes. One early warning sign may be a skin condition called Acanthosis Nigricans. High insulin levels will increase the production of skin cells. This causes patches of darkened and shiny skin in parts of the body, commonly in arm pits, groin, back of the neck or elbow. It is most common in Native Americans, followed by African Americans, Hispanics, and Caucasians.

Since prediabetes is a stage before you develop diabetes, you may gradually start having symptoms of diabetes. These include-

  • Increased hunger or thirst
  • Unintentional weight loss
  • Frequent urination
  • Increased tiredness
  • Wounds or cuts won’t heal fast.

 

WATCH THIS INFORMATIVE VIDEO FROM CDC TO FIND OUT MORE…….

How is Prediabetes Diagnosed?

Prediabetes can be detected with one of the following blood tests-

  • Hemoglobin A1c test. This blood test reflects the average blood sugar level over the past 3 months. This is probably the most reliable test for diabetes. An A1c of 5.7-6.4% indicates prediabetes.
  • Fasting blood sugar level. This blood test measures blood glucose level in people who have not eaten anything for at least 8 hours. Fasting glucose levels of 100-125 mg/dL indicate prediabetes.
  • Oral glucose tolerance test (OGTT). This test is done after 8 hours of fasting. The blood is drawn 2 hours after drinking a sweet liquid. A blood glucose level of 140-1 99 mg/dL is diagnostic of prediabetes.

Who Should be Tested for Prediabetes?

  • The American diabetic Association (ADA) recommends testing for prediabetes after the age of 45 years or older. Anyone who is overweight or obese with risk factors should also be tested regardless of their age.

Risk Factors for Prediabetes

  • Family history (parents and siblings) of diabetes.
  • If you are African American, Hispanic, American Indian, Asian American, Alaska native.
  • High blood pressure
  • Inactive or sedentary lifestyle
  • History of gestational diabetes
  • If you gave birth to a baby weighing more than 9 pounds
  • People with polycystic ovary syndrome
  • HDL cholesterol below 35 mg/dL or triglyceride level above 250 mg/dL
  • If you have heart disease or history of stroke
  • If you have other conditions associated with insulin resistance such as obesity or have patches on your skin called acanthosis nigricans

Insulin Resistance

Prediabetes usually occurs in people who already have insulin resistance. Insulin is a hormone produced by the pancreas. Insulin plays an important role in digesting the food for energy. Insulin helps your body cells throughout the body to absorb glucose and use it for energy. In a healthy person, this will allow blood glucose and insulin levels to remain in the normal range.

Insulin resistance is a condition where the body produces insulin but does not use it effectively. This will lead to the increased glucose levels in the blood instead of the glucose being absorbed by the cells.

In insulin resistance, muscle, fat, and liver cells do not respond properly to insulin and thus cannot easily absorb glucose from the blood stream. This will result in body needing more and more insulin making it harder to control the blood sugars. This will lead to type 2 diabetes and prediabetes because the body is unable to keep up with the increased need for insulin.

What causes insulin resistance?

Being overweight or obese is the main reason for insulin resistance. Excess fat especially around the waist is believed to be the main cause of insulin resistance.

Sedentary lifestyle. In the body, more glucose is used by muscle than any other tissue. Studies have shown that exercise will make the muscles more sensitive to insulin, thus reversing insulin resistance and lowering blood glucose levels.

Can insulin resistance and prediabetes be reversed?

Studies have shown that increasing the physical activity and losing at least modest amount of weight will reverse and prevent or delay diabetes.

How is prediabetes treated?

1. Lifestyle modifications-

Diet and exercise are the 2 most important interventions in treating prediabetes or preventing diabetes.

In a study of more than 3000 patients with prediabetes, published in New England Journal of Medicine, lifestyle-modification program with the goal of at least a 7% weight loss through low-calorie, low fat diet and and at least 150 minutes per week of moderate intensity physical exercise, such as brisk walking, lead to a 58% risk reduction of diabetes.

This study showed that for every 1 kg decrease in weight, the risk of developing diabetes in future was reduced by 16%. So eating healthy, along with exercise and maintain healthy weight are the key to preventing diabetes.

2. Metformin

Metformin is the only medication that has consistently shown to be beneficial in preventing diabetes. It prevents the liver from producing more glucose when you don’t need it and keeps your blood glucose level in a better range. Although metformin is not as good as lifestyle modifications described above, it reduces the risk of developing type 2 diabetes by 42%.

3. Weight loss surgery

Surgery for weight loss such as gastric bypass, gastric sleeve, lap band will reduce the risk of developing diabetes or resolve prediabetes altogether. Studies have shown that weight loss surgery may completely normalize the blood sugars in 78% of people with previous diabetes and in 98% of people with prediabetes.

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REFERENCES:

1. Bansal N. Prediabetes diagnosis and treatment: A review. World J Diabetes.
2015 Mar 15;6(2):296-303.
2. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM; Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002 Feb 7;346(6):393-403.