Pre-diabetes and its prevention

Diabetes has become a burgeoning epidemic all over the world. Every year a further 7 million people develop diabetes. Pre-diabetes is a precursor to type-2 diabetes.

According to some estimates, 40.1% adults aged 20 and older have pre-diabetes, which is a condition where blood glucose levels are higher than normal but not high enough to be called diabetes.

This condition is also called impaired fasting glucose (IFG) or impaired glucose tolerance (IGT). People with pre- diabetes are at increased risk of developing type-2 diabetes. It is estimated that most people with pre-diabetes will develop type 2 diabetes within 10 years unless measures are taken to prevent it. It is diagnosed by the following criteria.

Fasting blood glucose level of:
o 110 to 125 mg/dL - WHO criteria
o 100 to 125 mg/dL - ADA criteria

The PP (Post Prandial) blood sugar level of 140 to 199 mg/dL

Glycosylated hemoglobin (HbA1c) between 5.7 and 6.4 %

The doctors are recognizing the importance of diagnosing the pre-diabetes, as its treatment may prevent serious health problems. The experts now know that health complications associated with type-2 diabetes occur before the diagnosis of the disease.

Prevention of pre-diabetes- Good lifestyle choices are extremely important for prevention of diabetes. A recent research study called the Diabetes Prevention Program (DPP) found that many people who made healthy changes in their diet and increased their physical activity were able to prevent diabetes. The DPP found that 30 minutes of moderate physical activity a day coupled with 7% weight loss produced almost 60% reduction in diabetes.

The following measure should be adopted to prevent pre-diabetes.

• Weight reduction- A loss of 5% to 10% of weight will help prevent or at least delay the onset of type-2 diabetes. A person having pre-diabetes must try his best to maintain the standard weight for his height.
• Make healthy food choices- Limiting the amount of saturated fat and eating more fruits and vegetables and minimizing the consumption of sugar and sugary juices and drinks will help. Consuming foods with low GI (glycemic index) and limiting or stopping the consumption of fast food will a healthy choice.
• Keep blood pressure and cholesterol under check- Regular check-up and management of high blood pressure and cholesterol will reduce the burden produced by pre-diabetes on the heart and vascular system. Blood pressure in higher range of normal called pre-hypertension (defined as 120-139/80-89) also impacts the health. So in general, the blood pressure should not go above 130/ 80 mm. of Hg.
• Exercise program- A regular and consistent schedule of exercise goes a long way in preventing pre-diabetes. WHO recommends aerobics like walking, jogging, cycling, swimming etc. at least for 30 minutes a day on most days of week and weight bearing exercises with weights or body weight and stretching (flexibility) exercises at least 3 days a week.
• Take adequate sleep- 7 to 8 hours of good quality sleep daily will prevent pre-diabetes to occur. It has been found that sleep deprivation is associated with higher levels of glycosylated hemoglobin in young adults.
• Manage stress- A good management of stress is also important to avoid pre-diabetes.
• Stop smoking- Smoking is harmful for people with diabetes. Nicotine causes large and small blood vessels to harden and narrow resulting in reduced blood flow to rest of the body. No matter how much and how long one has smoked, stopping it will lower the risk of heart disease and other health problems.

Sometimes the above measures may fail to manage pre-diabetes and, therefore, drugs may be required to manage it. Oral ant-diabetic drugs used commonly are metformin and acrabose. Some studies indicate that pioglitazone and similar drugs also improve insulin sensitivity. These drugs may reduce the risk of converting pre-diabetes to diabetes but they are associated with weight gain and water retention.

It has been found that about 50% of people with IGT or IFG will develop diabetes. People with pre-diabetes have an increased risk of developing cardiovascular disease (CVD) and all cause mortality. So, in view of the seriousness of the condition of pre-diabetes, it is necessary to prevent it from developing into full-fledged diabetes.