Tuesday, October 10, 2006 Dumaguing: Facts about pre-diabetes By Dr. Vic Dumaguing To Your Health
WHAT is pre-diabetes? Pre-diabetes is a condition where blood sugar levels are higher than normal, but not yet high enough to be diagnosed as diabetes. Pre-diabetes is a key stage in the development of type 2 diabetes.
However, not everyone with pre-diabetes goes on to develop type 2 diabetes. Pre-diabetes is characterized by disturbance in blood sugar levels as measured by impaired glucose tolerance (IGT) or impaired fasting glucose (IFG). Patients can have one or both of these conditions to be considered pre-diabetic.
Worldwide, 230 million people have diabetes and in 2003, more than 300 million people were estimated to have pre-diabetes. By 2025, it is estimated that approximately 500 million people will have pre-diabetes. At present, Southeast Asia has the highest number of people with pre-diabetes. By 2025, it is estimated that Southeast Asia will continue to have the highest prevalence of pre-diabetes (13.5 percent), followed by Europe (10.9 percent).
How is pre-diabetes diagnosed? Pre-diabetes may not cause easily recognized symptoms and can only be diagnosed with blood sugar tests such as the fasting plasma glucose test (FPG) which measures a persona blood sugar first thing in the morning before eating and the oral glucose tolerance test (OGTT) which measures a persona blood sugar after fasting and again two hours after drinking a sugar-rich drink.
IFG: The most recent World Health Organization (WHO) guidance on diabetes defines normal fasting blood glucose as below 6.1 mmol/l (110 mg/dl); levels between 6.1 mmol/l (110 mg/dl) and 7.0 mmol/l (126 mg/dl) signal pre-diabetes. The American Diabetes Association defines normal fasting blood glucose as below 100 mg/dl; levels between 100 and 125 mg/dl signal pre-diabetes.
IGT: The World Health Organization (WHO) and International Diabetes Federation (IDF) associate levels between 7.8 mmol/l (126 mg/dl) and 11.0 mmol/l (140 mg/dl) with pre-diabetes. At present, the American Diabetes Association defines normal blood glucose as below 140 mg/dl two hours after the drink; levels are between 140 and 199 mg/dl, are indicative of pre-diabetes.
What are the primary causes of pre-diabetes? Pre-diabetes occurs when the body does not respond properly to its own insulin, a condition called insulin resistance, which causes glucose levels in the blood to be raised but not enough to be classified as type 2 diabetes.
Insulin is produced and secreted by β-cells in the pancreas and it has been demonstrated that there is a progressive loss of β-cell function in patients with pre-diabetes and type 2 diabetes.
Who is at greatest risk for developing pre-diabetes? People who are 45 years old and above and overweight; people who are 45 years old and above with normal weight may be at risk for pre-diabetes if they have other risk factors for type 2 diabetes, such as family history, high blood pressure and high cholesterol; People who are younger than 45 years old and overweight may be at risk for pre-diabetes if they have other risk factors for type 2 diabetes, such as family history, high blood sugar or belong to an ethnic or minority group at high risk for diabetes; and people of certain ethnic groups, such as those of Aboriginal, Hispanic, Asian, South Asian or African descent.
Does everyone with pre-diabetes develop type 2 diabetes? Although people with pre-diabetes are at an increased risk for developing type 2 diabetes, not everyone goes on to develop the disease. Large clinical outcomes trials have demonstrated that: Between 29 percent and 55 percent of people with pre-diabetes develop type 2 diabetes over the course of three years. In other trials of longer duration, these rates increased to between 43 percent and 68 percent over six years.
One large prevention study, the Diabetes Prevention Program (DPP), showed that over the three years of study, diet and exercise dramatically reduced the chances that a person with IGT would develop diabetes.
According to the DPP findings, people with pre-diabetes are likely to develop type 2 diabetes within 10 years, unless they are able to lose seven percent of their body weight through intensive lifestyle modification.
Why is it important to manage pre-diabetes? Pre-diabetes is a key stage in the development of type 2 diabetes. Type 2 diabetes is associated with a number of serious, long-term complications resulting from chronically elevated blood sugar concentrations damaging blood vessels and nerve cells.
People with pre-diabetes have a 1.5-fold risk of cardiovascular disease compared to people with normal blood sugar levels. High glucose levels, even for short periods, can lead to serious complications. Diabetes damage in small blood vessels can lead to blindness, kidney failure and amputation.
Damage to larger blood vessels can result in heart disease, high blood pressure and stroke. In fact, some of these complications may already be occurring in people with pre-diabetes.
(October 10, 2006 issue) Write letter to the editor. Click here. Join the Sun.Star message board. Click here.
