Pre-diabetes refers to a medical condition where blood glucose levels are higher than normal, but not abnormally high to be labeled as diabetes.
Pre-diabetes has been shown to have harmful effects on the body in the long run, and is a disease that Indians need to be concerned and informed about.
A pandemic of obesity and diabetes is occurring. Diabetes now affects an estimated 24.1 million people in the United States, an increase of over three million people in approximately two years.
Another 57 million people in that country have pre- diabetes, some of whom in fact already have micro-vascular changes (such as blindness, amputations and kidney failure) consistent with diabetes.
In India, over 30 million have been diagnosed with diabetes. The CPR (Crude Prevalence Rate) in the country's urban areas is thought to be about nine per cent. In rural areas, the CPR is approximately three per cent of the total population. Another estimate says that the actual number of diabetics in India is around 40 million. As far as the pre-diabetic population is concerned, only China surpasses India, and by 2025,every fifth diabetic in the world will be an Indian.
IGT (Impaired Glucose Tolerance) is also a mounting problem in India. The prevalence of IGT is thought to be around 8.7 per cent in urban areas and 7.9 per cent in rural areas, although this estimate may be too high. It is thought that around 35 per cent of IGT sufferers go on to develop Type 2 diabetes. So, India is genuinely facing a healthcare crisis and the type of diabetes that its people suffer from differs considerably from what patients in the West suffer from.
Pre-diabetes currently refers to people who have impaired fasting glucose (IFG) i.e. fasting glucose levels between 100- 125mg/dl or impaired glucose tolerance (IGT), i.e. two hours post glucose load between 140-199mg/dl or both. Pre-diabetes raises short-term absolute risk of Type 2 diabetes five to six fold, and in some populations this maybe even higher.
As the prevalence of and progression to diabetes continues to increase, diabetes-related morbidity and mortality have emerged as major public health care issues.
People with diabetes are vulnerable to multiple and complex medical complications. These complications involve both cardiovascular disease (heart disease, stroke) and peripheral vascular disease) and microvascular disease.
Epidemiologic evidence suggests that these complications of diabetes begin early in the progression from normal glucose tolerance to frank diabetes.
Early identification and treatment of persons with pre-diabetic conditions has the potential to reduce both the incidence of diabetes and related cardiovascular and microvascular disease. Therefore, the following steps need to be considered:
Management of pre-diabetes:
The management of pre- diabetes involves a set of global treatment measures designed to address its abnormalities. The preferred treatment approach for all the abnormalities of persons in this group is intensive lifestyle management, given its safety and the strong evidence of efficacy of this approach in improving glycemia and reducing cardiovascular risk factors such as hypertension and Dyslipidemia.
Persons with pre- diabetes should reduce weight by 5-10 percent with long-term maintenance at this level. Even modest weight loss (seven to ten percent of body weight) results in decreased fat mass, blood pressure, glucose, low density lipoprotein, and triglyceride levels. These benefits can also translate into improved long-term outcome, especially if weight loss and lifestyle alterations are maintained.
A program of regular moderate-intensity physical activity for 30-60 minutes daily, at least five days a week is recommended.
The diet should be low in total, saturated fat and trans-fatty acids and with adequate dietary fiber. Specifically for blood pressure, lifestyle recommendations would include lower sodium intake and avoidance of excess alcohol.
Blood Pressure in pre-diabetes:
Pre-diabetic patients should achieve the same target blood pressure currently recommended for persons with diabetes, systolic 130 and diastolic 80mmHg.
Lipid goals in pre-diabetes:
Persons with pre- diabetes should achieve the same lipid goals as those with established diabetes i.e. cholestrol, non - HDL cholestrol, or apoB treatment goals of 100mg/dl, 130mg/dl, and 90mg/dl respectively.
Monitoring in pre-diabetes:
Monitoring of patients with pre diabetes to assess for worsening of glycemic status should include regular blood sugar test and testing for micro-albuminuria. Those patients at highest risk should be more carefully monitored. Fasting blood sugars, Glycosylated haemoglobin (index of sugar control in last three months) and lipid profile should be followed at least twice a year. If the results of monitoring reveal worsening hyperglycemia, intensified lifestyle and treatment with anti - diabetic medicines must be considered. (ANI)
Dr. Vikas Ahluwalia is a Senior Consultant in Diabetes and Metabolism and President, Diabetes Care Foundation Of India. He can be contacted on [email protected]
By Dr. Vikas Ahluwalia (ANI)