Prediabetes: its symptoms and the most important ways to prevent it

Prediabetes: Preventable Diabetes

Diabetes has grown to pandemic proportions. it's estimated that 8.3% of the US population, or 25.8 million people, have diabetes. About 95% of those have type 2 diabetes. Diabetes is the main explanation for renal failure, limb amputation, and new-onset blindness in American adults. People with diabetes are more likely than people without diabetes to develop and die from diseases of the guts and blood vessels, called disorder. Adults with diabetes have heart condition death rates about two to fourfold above adults without diabetes. the danger for stroke is 2 to fourfold higher among people with diabetes.

Prediabetes refers to the intermediate metabolic  between normal and diabetic glucose homeostasis. This term was first introduced in 1979 to exchange 'borderline' diabetes. Pre-diabetes is becoming more common and more recognized within us. The U.S. Department of Health and Human Services estimates that 79 million Americans had prediabetes in 2007. it's estimated that 314 million people worldwide have prediabetes, and therefore the number is projected to grow to 418 million in 2025.

Why worry about prediabetes? it's been estimated that between 35% and 65% of adults with prediabetes will develop type 2 diabetes within six years of the prediabetes diagnosis. Even before progressing into full-blown diabetes, these people have an increased rate of microvascular (retinopathy, a protein within the urine, polyneuropathy) and macrovascular (heart attack and stroke) complications.

How does one diagnose Prediabetes? Prediabetes is typically diagnosed with anybody or more of the subsequent biopsy readings: A fasting blood sugar level of:110 to 125 mg/dL (6.1 mM to 6.9 mM, consistent with the planet Health Organization criteria or 100 to 125 mg/dL (5.6 mM to 6.9 mM), consistent with the American Diabetic Association criteria. A blood glucose level of 140 to 199 mg/dL (7.8 to 11.0 mM) at the top of two hours after ingesting a uniform 75 gm glucose solution as a part of a two-hour glucose tolerance test. Glycated hemoglobin (HbA1c) between 5.7 and 6.4 percent.

Are you at risk? There are certain indications that you simply have or could also be at an increased risk of developing prediabetes. These include increasing age, inactivity, sleeping but 6 hours per day, and being overweight or obese. Certain races are at an increased risk, namely Asian Americans, Hispanics/Latinos, and non-Hispanic blacks. Other risk factors include abnormal lipids, especially high triglycerides and low HDL (the good cholesterol), and diagnosed disorder. If you had gestational diabetes (high blood glucose during pregnancy) or gave birth to a toddler weighing quite 9 lbs, you're also in danger. Two other rather uncommon conditions, namely polycystic ovarian syndrome and acanthosis migrants also indicate increased insulin resistance and predisposition to prediabetes and diabetes. and eventually, patients with psychiatric disorders, especially schizophrenia, on multiple psychotropic drugs, even have a high incidence of prediabetes.

Symptoms: Prediabetes is usually asymptomatic and suspicion often rests solely on risk factors mentioned above. If present, the symptoms of prediabetes, are an equivalent to those of diabetes: constant hunger, increased thirst, and urination, unexplained weight loss, weight gain, generalized malaise, blurred vision, slow healing from minor wounds like cuts and bruises, tingling or loss of sensation within the hands or feet, frequent or recurring gum, skin, vaginal or bladder infections.

How does one treat? the decision for early treatment of prediabetes is gaining momentum. Several recent studies have evaluated the role of lifestyle changes and medications for the treatment of this malady:

1. Exercise: Regular physical activity prevents progression into diabetes. within the Da Qing IGT and Diabetes Study of 110,660 men and ladies in China( Diabetes Care 1997;20:537-44.), progression to diabetes decreased from 67.7% to 41.1%, when comparing an uncontrolled group to a controlled exercise group over 6 years.

2. Diet: during a Finnish study (N Engl J Med 2001;344:1343-50), there was an incidence of 23% of progression into diabetes during a control group compared to only 11% in an intervention group over 4 years. Interventions were aimed toward reducing weight 5% or more, reducing dietary fat too but 30% of the entire caloric intake and increasing dietary fiber to a minimum of 15g per 1000 calories ingested.

3. In al large study involving 27 clinical centers around the US(N Eng J Med, February 7, 2002),3234 prediabetic overweight participants were divided into two groups. One group received intensive training in diet, physical activity, and behavior therapy. The aim was to scale back weight by 7% and maintain the loss and exercise 150 minutes every week. The second group received metformin 850 mg twice each day. At the top of the study, the lifestyle intervention group reduced diabetes progression by 58% compared to 31% within the metformin group.

4. A prediabetes task force (American Association of Clinical Endocrinologists 18th Annual Meeting, Houston, Tx. 2009) suggested a more aggressive therapeutic approach to those patients, recommending treating high-risk individuals with diabetic medications like metformin, acarbose, glucagon-like peptide 1 agonists, and thiazolidinediones. These treatments aren't yet FDA approved for prediabetes, but are backed by strong scientific data indicating that battling insulin resistance early protects the pancreas and prevents progression into diabetes.

The health and monetary costs of prediabetes aren't known. But diabetes is an upscale disease, costing about $174 b billion annually within the US alone. Direct medical costs account for about $116 billion and indirect costs like disability payments, time lost from work, and premature death account for the remaining $58 billion.

Millions of lives and billions of dollars are often saved by aggressive life-style and therapeutic intervention in patients affected by prediabetes.

Remember: Prediabetes means preceding diabetes. But it also means preventable diabetes.

Dr. Shashi K. Agarwal may be a Board Certified Internist and Cardiologist with a personal practice in NY City and New Jersey. he's also a diplomat of the American Board of medical care and therefore the American Academy of Anti-Aging Medicine

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