Dr. Awadhesh Sharma

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 factor 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.

Global Burden

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.

Southeast Asia currently 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).

Diagnosis Criteria

• One test is not enough!• The diagnosis must be done by a physician.

Normal Pre diabetes

Diabetes

Fasting Blood Glucose Test (FBG)*

Less than100

Between 100 - 125

More than or equal

to 126

Glucose Tolerance Test (GTT) **

Less than 140

Equal to or more than 140 but

less than 200

More than or equal to 200

* FBG blood test is done after fasting 8 hours.

** GTT results are repeated after 2 hours. A person drinks a 75 mg glucose solution before test. 100 mg for Pregnant women.

Why We Worry About Prediabetes?

• Predicts high risk for development of diabetes

• Predicts high risk for development of

atherosclerotic vascular disease

• Both are largely preventable through lifestyle and

pharmacologic interventions

Risk of Cardiovascular Disease Is Elevated Prior to Diagnosis of T2DM

6.00

12.00

18

27

0.00

5.00

10.00

15.00

20.00

25.00

30.00

Normal IGT New DM Previous DM

% w

ith

CV

D

*MI=myocardial infarction.

Adapted from: Hu F, et al. Diabetes Care. 2002;25:1129-1134.

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.

Symptoms of Prediabetes

• Symptoms of diabetes appear when the levels of glucose are either very high or very low.

• Many persons with diabetes and all those with pre-diabetes do not have symptoms.

• The most common symptoms are:

o Fatigue, tiredness or lack of energy

o Excessive constant thirst or hunger

o Frequent need to urinate

o Skin wounds that do not heal or heal very slowly

o Blurred vision

Risk Factors for the Development of S Prediabetes

• Family history of diabetes

• Class of obesity

– Especially central

• Hypertension

• High triglycerides

• Low HDL-C

• Elevated glucose

• Ethnicity other than Caucasian

• Vascular disease• History of gestational

diabetes• History of baby weighing > 9

lbs• Sedentary lifestyle

RISK FACTORS THAT CAN BE MODIFIED

Overweight and obesity

Sedentary lifestyle

An increase of lipids (fats) in the blood

High blood pressure

NON-MODIFIABLE RISK FACTORS

Increasing age

Family History: Inheritance

Background of Gestational diabetes

Race/Ethnic group

Body Mass Index (BMI)

18.5 - 24.9 = NORMAL

25 - 29.9 = OVERWEIGHT

30 & MORE = OBESITY

•Persons with BMI >25 have risk of Diabetes

• BMI combines height and weight measurements

• Read the result in a BMI chart.

The normal values are:• WOMEN = 34” or 95 CM

• MEN= 37” or 100 CM

HIGHER VALUES = HIGH

RISK OF DIABETES

Waist Circumference (WC) It is a simple measurement at waist level

Sedentary Lifestyles

•Lack of exercise

•The comforts of modern living

Increase of Lipids (Fats) in the Blood

A person is at risk of developing diabetes if,•The levels of HDL are low•The levels of LDL are high•The levels of TRIGLYCERIDES are high

Lipids Normal ValuesTotal Cholesterol

Less than 200 mg/dl

• LDL cholesterol

Less than 100 mg/dl

• HDL cholesterol

Men: Higher than 45 mg/dl Women: Higher than 55 mg/dl

Triglycerides Less than 150 mg/dl

High Blood Pressure

A person is at risk of developing diabetes if blood pressure is 140/90 mm Hg or more.

A person with diabetes has more risk of complications if blood pressure is 130/80 mm Hg or more.

Aims and objectives To study microvascular and

macrovascular complications in prediabetes

Material & Methods The study entitled “Study of Microvascular & Macrovascular

Complications in Prediabetics (Impaired Glucose Tolerance)”

was conducted in the department of Medicine of M.L.B.

Medical College, Jhansi from the period of June 2006 to

September 2009. The cases were patients coming to

Medicine OPD and in the emergency being admitted in the

Medicine ward as cases of impaired glucose tolerance or

prediabetes.

Fifty patients of prediabetes were included in the study

which are selected from Medicine OPD and those who

admitted in the Medicine ward.

Distribution of cases according to sex

Male80%

Female20%

0

3

6

9

12

15

18

21

No

. o

f ca

ses

20-29 30-39 40-49 50-59 60-69 70-79

Age (in years)

Distribution of cases according to age

0

5

10

15

20

No

. o

f ca

ses

40-49 50-59 60-69 70-79 80-89

Weight (in Kg)

Distribution of cases according to Weight

0

5

10

15

20

25

No

. o

f ca

ses

140-149 150-159 160-169 170-179

Height (in cm)

Distribution of cases according to Height

Distribution of cases according to risk factors (Hypertension)

20%

80%

Hypertensive Non Hypertensive

Distribution of cases according to risk factors (Dyslipidemia)

40%

60%

Dyslipidemia Normal

0123456789

10111213

No

. o

f cases

Hypercholesterolemia

Increaesd LDL Decreased HDL IncreasedTriglyceride

Type

Distribution of cases according to type of dyslipidemia

Distribution of cases according to risk factors (Obesity)

30%

70%

Obese Normal

Distribution of cases according to type of BMI

16%

10% 2% 2%

70%

Preobese Obese class I Obese class II Obese class IV Other

Distribution of central obesity according to sex

34%

16%

50%

Male Female Without central obesity

Distribution of cases according to risk factors (Smoking)

56%

44%

Smoker Non smoker

Distribution of cases according to risk factors (Family H/o diabetes)

60%

40%

Family H/o Diabetes No family H/o diabetes

Macrovascular complications in prediabetics

16%

20%

6%8% 8% 2%

40%

Progression to frank diabetes Cardiovascular

Cerebrovascular Peripheral vascular disease

Retinopathy Nephropathy

Normal without complications

Macrovascular complications at the time of presentation (Cardiovascular)

4%4%

12%

80%

Stable Angina NSTEMI Unstable Others

Macrovascular complications at the time of presentation (Cerebrovascular)

2%4%

94%

TIA Ischemic episode Others

ResultsThe following conclusions can be drawn from the present study :-

1. Annual progression to diabetes inprediabetics was 5% per year.

2. Majority of them (prediabetics) suffered from cardiovascular complications i.e. 20%.

3. Incidence of cerebrovascular complications is 6%.

4. Incidence of peripheral vascular disease is 8%.

5. Incidence of retinopathy is 8%.

6. Incidence of nephropathy in the form of microalbuminuria is 4%.

7. Incidence of complications is more in subjects having multiple risk factors.

Health

Physical ActivityPhysical Activity

++

Sound NutritionSound Nutrition

Good HealthGood Health

HealthThe first part of our equation is

activityGet moving, find something you enjoy

HealthThe second part of the equation is

nutrition Your body needs the right fuel to help it work

well.

How Can You Help Reduce Your Risk of Diabetes?

Eat foods low

in fat & calories.

If overweight,

lose weight. Physical activity

Stop smoking!

Limit alcohol to 1-2 drinks per day.

Take your medications regularly.

Encourage people to change habits.

Use the pyramid guide to educate people to eat healthy.

Is drug therapy useful in patients with pre-diabetes?

Drug therapy is not recommended by the ADA due to the limited

efficacy of treatment versus lifestyle modification, potential for

adverse drug reactions, lack of data supporting reduction of

microvascular or macrovascular complications of diabetes in this

patient population, and insufficient assessment of the cost-

effectiveness of drug treatment. However, not all patients are able

to implement lifestyle modifications due to physical or other

limitations, and based on limited data available, drug therapy may

be a reasonable option to delay onset of type 2 diabetes and provide

a cardiovascular benefit (TRIPOD and STOP-NIDDM data).

THANK YOU