Could you be pre-diabetic?
PRE-DIABETES, according to internist Dr Jomo James, is a term used to describe a subset of people who have higher than normal blood glucose but are not yet at a level to be designated as diabetics.
“This means their sugar levels lie between those of normal subjects and those of individuals with full-blown diabetes. There are no symptoms of diabetes (asymptomatic) such as increased urination, increased thirst, weight loss and others, and in fact the abnormality only comes to detection through blood screen test. There may be, however, risk factors that are clearly evident,” Dr James said.
According to the internist these mainly include:
1. Being overweight or obese, and the more overweight the higher the risk.
2. Poor diet, or a diet rich in carbohydrates and a diet rich in fat.
3. Poor lifestyle decisions such as smoking, alcohol and a sedentary lifestyle.
Dr James explained that the term pre-diabetes is also used for individuals who would otherwise develop type 2 diabetes or diabetes not usually requiring insulin therapy.
The importance of this subset of individuals and why this classification came to the fore in the past two decades are threefold.
He said research has shown that glucose levels between normal and diabetic predisposes to increased vascular diseases such as cardiovascular disease and hypertension above the usual norm.
He further explained that pre-diabetes does progress to diabetes but the rate is dependent on the population and usually progresses to full diabetes in three to four years in a quarter or 25 per cent of people, and if there’s no intervention, then universally by 10 years. “It does therefore offer a screening tool to identify those patients who will benefit from aggressive intervention to slow this progression,” he said.
According to Dr James, pre-diabetes can be diagnosed by the same routine blood screening test for diabetes in which the following are done:
1. Fasting glucose test
Dr James said this is where your glucose is tested early in the morning after an eight-hour overnight fast.
2. A glucose challenge test
“Here you’re given a precise amount of glucose mixed with water to drink and your glucose level is checked two hours later,” he said.
3. The glycated haemoglobin test/HbA1c
Dr James said this is a test which usually reflects the state of glucose levels in your blood for the past three months.
He explained that depending on the values, you may fall in one of three categories, which is either normal, pre-diabetes, and/or diabetes.
Dr James further explained that pre-diabetes is likely to be detected in one’s 40s or 50s as that is the time, particularly in our population, that your private physician will screen for diabetes.
“By convention, screening for diabetes should start at age 45 — outside of overt risk factors, and if the tests described above are normal, then the testing is repeated every three years. But for those considered at higher risk for diabetes, screening should start earlier,” he said.
He added: “Pre-diabetes is considered a warning sign for the future development of diabetes progression, but it is not inevitable and it should be viewed as an opportunity to improve your health. It is well documented that promotion of healthy lifestyle changes, proper diet, weight loss and regular exercise do prevent or slow down progression to diabetes. In addition, limited alcohol consumption and cessation of smoking also helps.”
He emphasised that pre-diabetes is a warning that should be a red flag that the path to diabetes is fast approaching and may be inevitable if lifestyle changes are not made.
