Preventing diabetes: is it possible?

Yes,diagnosing and controlling prediabetes in time can help you in preventing diabetes by nearly 60%

In most people, type 2 diabetes is preceded by a prediabetes, which eventually progresses to diabetes in a few years. Controlling the lifestyle factors leading to prediabetes can help you in preventing  diabetes

What is prediabetes? Are there any prediabetes symptoms?

Prediabetes is a condition in which your blood sugar levels are not normal, but fall short of the diabetic levels. Prediabetes if often part of a risk complex called metabolic syndrome. If your Fasting Blood Sugar is more than 100 mg/dL but below 126 mg/dL, then you are a prediabetic

There are no symptoms of prediabetes; in fact, the symptoms appear late in case of type 2 diabetes also. When symptoms do appear, they are mostly due to complications of diabetes such as neuropathy etc.

The text book symptoms: excessive hunger, thirst and urination,  are not present in most diabetics or prediabetics

This means that if you do not get tests for diabetes/prediabetes detection done in time, you could land up with complications

You should get tests done to detect prediabetes and metabolic syndrome if:

ICMR and ADA guidelines suggest that Indian adults should get tests done if he/she

  • is overweight (BMI>23) or
  • has abdominal obesity (Waist Circumference> 90 cms  for men and >80 cms  for women) or
  • has sedentary lifestyle
  • has family history of diabetes
  • have high blood pressure, high blood cholesterol or triglycerides or
  • has fatty liver
  • is a woman with history of GDM (Gestational Diabetes Mellitus)
  • Any adult over 30, even the ones without the above mentioned conditions

Tests for prediabetes :

Fasting Blood Sugar or Glucose (FBS or FBG)

The gold standard test to diagnose prediabetes is Fasting Blood Glucose (FBG)

ICMR and WHO define normal  FBG value as less than 110 mg/dL, Impaired Fasting Glucose between 110-125 mg/dL and diabetes as more than 126. But ADA defines normal FBG as

FBG value of 126 mg/dL or more is diagnostic of diabetes, a repeat FBG or HbA1c test confirms this diagnosis

But if your FBG lies between 110 and 125 (or 100 and 125 as per ADA), you have Impaired Fasting Glucose, a subtype of prediabetes.

You need to have one of the two additional tests: WHO – Oral Glucose Tolerance Test (OGTT) or HbA1c, to further classify or confirm prediabetes

WHO Oral Glucose Tolerance Test (OGTT) or Post Glucose Blood Sugar(PGBS)

In this test a fasting person is given 75 gms of glucose with water and his blood glucose level is tested after two hours. If the Post Glucose Blood Sugar (PGBS) is more than 200, it means the person has diabetes, if it is between 140 and 200, the person has Impaired Glucose Tolerance

People with both IFG and IGT have more than 10 times the normal risk of developing diabetes eventually

Glycosylated hemoglobin or HbA1c

HbA1c can also be used for screening for diabetes or prediabetes. But to confirm the diagnosis FBG and PP or PGBS needed. Also, HbA1c may not give correct information in anemia or hemoglobin disorders (To know more: go to: ‘HbA1c in diagnosis and management of diabetes‘)

HbA1c level of 6.5% or more is diagnostic of diabetes, HbA1c less than 6% (or 5.7% as per ADA) is considered normal, whereas values between 6 (5.7 as per ADA)  and 6.5% are suggestive of prediabetes

Tests for metabolic syndrome

Prediabetes and metabolc syndrome go hand in hand. So, it is wise to get tested for metabolic syndrome as well. For this you require to get the following tests/measurements:

Fasting Lipid Profile : Blood total, LDL and HDL cholesterol and TriGlycerdes (TG)

FBS:

Blood pressure:

Waist circumference:

To find out whether you have metabolic syndrome or not, read Metabolic syndrome diagnosis

Lifestyle modification for prediabetes and metabolic syndrome:

The mainstay of treatment for prediabetes and metabolic syndrome is lifestyle modification.

The lifestyle interventions which help in preventing diabetes are:

  • Weight loss: (5-10% of body weight or 10-15 pounds= 4.5-6.8 kilos)
  • Diet management:  GET the FWI diet plan for weight loss, which takes into consideration the needs of managing prediabetes by diet
  • Increased physical activity: more is better, but at least the recommended levels for adults should be your target
  • Avail medical help:
    • Metformin, a staple anti-diabetic medication, may be needed in some cases, such as very high BMI/ obesity, discuss with your doctor whether you need it
    • Cholesterol lowering drugs such as statins, may be needed if you have metabolic syndrome, discuss with your doctor
  • Get regular health check ups (every 1-3 years)
  • Quit smoking
  • Keep your alcohol intake in control

What is the impact of lifestyle modification in prediabetes

TheseMany studies have shown that lifestyle interventions  reduce the risk of progression to diabetes.

Most notably the DPPS study (Diabetes Prevention Program Study) which showed that by losing an average of 7 kilos  in the first year of the study, people reduced their risk of developing type 2 diabetes by 58 percent over 3 years.

The Diabetes Prevention Program Outcomes Study (DPPOS), which followed up on the participants for 10 years found that the benefits of weight loss and metformin last for at least 10 years

45 %of the participants for these studies, done in America, were from minority groups including Asian American, therefore their result could be considered relevant for people of Indian subcontinent

Prediabetes and diabetes, often associated with metabolic syndrome, increase the risk of CVD or heart disease many fold. Therefore, it is important to monitor your heart risk and know which target levels to aim for.

To know more about these, also read ‘Target levels of heart risk factors’ and ‘FWI preventive health check up and advice’

CHECK OUT: Our references for recommendations on weight management