In the previous posts, I have discussed about various aspects of diabetes management. Three major risk factors of diabetes are family history, obesity/overweight and sedentary life style. A question arises ‘Can diabetes can be detected before the onset of its sign and symptoms? Can the progression to diabetes be reversed. It is logical to think about a prediabetes like stage. The answer is definitely YES.
Within two hours of a meal, the blood glucose level usually comes back to normal. In some people this phase is prolonged. The blood sugar remains high for longer duration in these otherwise healthy individuals. This stage has been recognized as PREDIABETES. The blood sugar is above normal, but below the diabetic range. Prediabetes may be present upto 12-14 years before the actual diagnosis of diabetes. I will discuss in detail the prediabetes stage for the benefit of the readers who may be in prediabetes stage.
Definition of Prediabetes
As you know, diabetes is diagnosed by oral Glucose Tolerance Test (GTT). Diabetes is diagnosed if fasting plasma glucose level is >126 mg/dl and 2 hrs after 75 gms of glucose, the plasma glucose is above 200 mg/dl.
In Prediabetes, the diagnostic criteria of diabetes is not met, but at the same time the values are above normal range. Two major categories of prediabetes are recognized as under:-
(a) Impaired Fasting Glucose or IFG. When fasting plasma glucose (FPG) is between 100-126 mg/dl (Normal value is less than 100 mg/dl), it is termed as IFG. For measuring fasting plasma glucose, one should not consume anything except water, for 8 hrs before blood sample collection.
(b) Impaired Glucose Tolerance (IGT). During Oral glucose tolerance test (OGTT), the plasma glucose value is between 140 mg/dl and 200 mg/dl, after 2 hrs of the glucose load.
It is seen that IFG and IGT are common in population. Both of these are characterized by insulin resistance and impairment of insulin secretion. IGT/IFG occurrence indicates that the beta cell mass (cells responsible for insulin hormone) has been reduced by 40%. Progressive destruction of more than 60% will herald the development of frank diabetes. The prevalence of IFG or IGT increases with age. IFG is more in men but IGT is more common in women. Studies suggest that micro-vascular and macro-vascular complications are usually present even in prediabetes stage. Prediabetics, like diabetes patients, are also prone to develop cardiovascular diseases (eg atherosclerosis, hypertension renal complications and deranged lipid profile (dyslipedemia). You can go through my earlier posts for complications of diabetes.
Progression : Prediabetes to Diabetes
One third of prediabetics usually revert to normal, one third remain at prediabetes stage and remaining one third progress to frank diabetes. The rate of progression to diabetes is around 6-10% for IGT. If IGT and IFG co exists, it may go up to 65% within six years. The rate of progression depends on the life style of an individual. An individual may develop diabetes, if he is overweight, sedentary or has a family history of diabetes, unless suitable life style modifications are adopted.
Prediabetes: Its Significance
The causes for rising incidence of diabetes globally are not clear. What triggers beta cell destruction is yet a mystery. However, on a positive side, prediabetes stage gives us enough time to act and prevent diabetes. Once diabetes is contracted, its a life time problem. Cost of the treatment is high. All types of complications will occur in due course, reducing the quality of life. Adoption of healthy life styles at this stage will reverse the process in an individual. In the next post, I will deal with the action plan at prediabetes level.
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