PreDiabetes - Time to Prevent to be real Diabetic

24 April 2020

By Dr. Lim Kim Piow

PreDiabetes - Time to Prevent to be real Diabetic

In 2019, a total of 463 million people are estimated to be living with diabetes, representing 9.3% of the global adult population (20–79 years). This number is expected to increase to 578 million (10.2%) in 2030 and 700 million (10.9%) in 2045. The prevalence of diabetes in women in 2019 is estimated to be 9.0%, and 9.6% in men.

Prediabetes is when the blood sugar level is higher than it should be but not high enough for your doctor to diagnose diabetes. People with type 2 diabetes almost always had prediabetes first. But it doesn’t usually cause symptoms. The increasing prevalence of prediabetes could predict a greater increase in the incidence of type 2 diabetes than previously expected. About 84 million people over age 20 in the U.S. have prediabetes, but 90% don’t know that they have it.

Individuals with prediabetes have a higher risk of micro- and macrovascular complications including type 2 diabetes and problems with your heart, blood vessels, eyes, and kidneys. The health impact of prediabetes include long-term diabetic complications, reduction in health-related functioning, reduction of quality of life and reduced overall life expectancy as well. Long-term complications include myocardial infarction, cerebrovascular stroke and end-stage renal failure. It is thus urgent to take early steps including screening , prevention and early management in an attempt to control this evolving epidemic of prediabetes. Significant predictors of prediabetes include age, ethnicity, having a higher than normal weight, diagnosed high blood pressure and socioeconomic deprivation.

It has been shown that weight loss reduces conversion to type 2 diabetes in individuals at risk. For example, in the one of the research trial, lifestyle modification, consisting of a target weight loss of 7% together with 150 minutes of exercise per week, reduced conversion to overt diabetes by 58% over a mean follow-up of 2.8 years. Such data are reflected in current treatment recommendations for patients with prediabetes, which recommend lifestyle management as the cornerstone of treatment .

However, other clinical data cast doubt on whether lifestyle changes alone are sufficient to cause clinically significant weight loss over the long term.

Although intensive intervention reduced body weight compared with basic lifestyle advice, this effect diminished over time (median follow-up: 9.6 years).Reasons for the unsustainability of lifestyle changes are many and varied, and may include the persistence of a metabolic profile of starvation, which tends to restore body weight after weight loss, and that a supportive multidisciplinary team is unlikely to be available in routine clinical practice.

Given these considerations, pragmatic and effective treatment of obesity and prediabetes may require not only diet and exercise, but also pharmacotherapy and, possibly, bariatric surgery as an option for those patients not meeting treatment goals.

Treatment of obesity with pharmacotherapies as an adjunct to lifestyle modification may reduce the likelihood of progression from pre-diabetes to diabetes, thereby forestalling the rise in diabetes in the nation.

Drugs like metformin, thiazolidinediones, alpha-glucosidase inhibitors, orlistat and liraglutide have demonstrated preventive efficacy. Although these drugs delay the onset of diagnosis of diabetes, the benefit or harm of the intervention, independent of the effect on hyperglycemia, must be considered. In short, these drugs need to be prescribed and monitored under experienced clinicians who are trained in diabetes and obesity management.