How does it matter if my fasting blood sugar is 120 mg/dL and post meal, a little short of 200 mg/dL? What’s there to worry about?

The diagnosis of prediabetes is made by blood tests.
1. Fasting blood glucose 100 – 125 mg/dl (impaired fasting glucose, IFG)
2. Two hours after taking 75-gram glucose dissolved in water — blood glucose value between 140 and 199 mg/dl (impaired glucose tolerance, IGT)
3. HbA1c value between 5.7 to 6.4 per cent.

How many have prediabetes?

The global number of people with prediabetes probably exceeds a billion. With regard to India, the recently released ICMR – INDIAB study showed an overall prevalence of prediabetes of 15.3 per cent, while that of diabetes was 11.4 per cent. This indicates that more than 130 million people in India have prediabetes.

Why should we worry about it?

Prediabetes puts you at a greater risk of developing diabetes. A recent analysis showed that the yearly progression rate to diabetes in individuals with prediabetes is 3.5-7.0 per cent vs 2 per cent/year in those with normal blood sugar values. It is important to realise that all forms of prediabetes are not the same. If both fasting and post-glucose levels are high (combination of impaired fasting glucose and impaired glucose tolerance), the risk is the highest. This is followed by impaired glucose tolerance, with the lowest risk being in those with isolated rise in fasting glucose. Similarly, within the prediabetes zone, the level of HbA1c determines the risk for diabetes, with the five-year risk being 50 per cent if the HbA1c is >6 per cent and 25 per cent if it is between 5.7 and 6 per cent.

The lifetime risk of developing diabetes if you have prediabetes is 70 per cent or greater. Indians may have higher and faster conversion from prediabetes to diabetes. In a 10 year follow-up study from the Chennai-based CURES study, almost 20 per cent of those with normal baseline glucose levels converted to diabetes, whereas close to 60 per cent of those with prediabetes converted to diabetes.

The risks of prediabetes are not limited to the development of diabetes. Recent data suggests that prediabetes may increase the risk of vascular disease — heart attack and stroke — by 20 per cent. Some studies suggest that microvascular complications like neuropathy and retinopathy may also start increasing in the prediabetes stage.

Is diabetes inevitable if you have prediabetes?

The answer is NO. Prediabetes can also be interpreted as “prevent diabetes.” It comes down to your choice. With lifestyle measures like diet and exercise, you can lose excess body weight and reverse prediabetes to normal, or at least remain in the prediabetes range for a prolonged period of time without converting to diabetes. If you choose to ignore and look the other way, you can go down the steep slope of diabetes and attendant complications.

Prediabetes truly offers a window of opportunity. Intervention at this stage can reduce the risk of not just conversion to diabetes, but also vascular complications. Intensive lifestyle interventions were able to reduce the risk of developing diabetes by 29 to 67 per cent in different populations. As a rule of the thumb, up to 50 per cent cases of Type 2 diabetes can be prevented or delayed if intervention is introduced at the right time.

Who should get tested for prediabetes?

Since prediabetes produces no symptoms, testing is the only way to diagnose the condition. Otherwise it can easily remain under the radar without being diagnosed. In India, everybody should test their blood sugar annually starting at the age of 25. Others who should test early and regularly are those who are overweight, sedentary or have a first degree relative with diabetes. Overweight children with a family history should be first tested during puberty itself. Women with a history of diabetes during pregnancy, large sized babies, or polycystic ovarian disease are particularly at risk.

What can you do if diagnosed with prediabetes?

Most individuals with prediabetes are overweight. The primary goal, therefore, is healthy weight loss. About five to seven per cent weight loss goes a long way in improving glucose levels and reducing associated risks. The basic principles are as follows:

1. A healthy balanced diet, low in calories and refined carbohydrates, rich in fibre, protein and healthy fats is encouraged.

2. Regular physical activity, including cardio and strength training, at least 200 minutes a week.

3. Seven to eight hours of sleep at night

4. Keeping stress at bay.

Can medication be used for treating prediabetes?

In case lifestyle measures fail to stop the progress of prediabetes over three to six months, oral medication like Metformin or Acarbose can be used. This is particularly true of those who have both fasting and post glucose values in the prediabetes range, as they are at much greater risk of progressing to diabetes. The future will possibly see a greater use of the GLP1-based weight loss agents in prediabetes to reduce weight and prevent diabetes.