Pre-diabetes is defined as the higher blood glucose levels than normal range but not high enough to be diagnosed as diabetes. That is why it is also called as the Borderline diabetes.
It occurs in those people who already have some insulin resistance or whose pancreatic beta cells do not produce enough insulin to keep blood glucose in the normal range.
It does not show any clear symptoms for years, so there is a high chance that it often goes undetected until serious health problems shows up.
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In the United States, it is estimated that 84 million adults in the USA have prediabetes in 2015 and that’s about 1 out of 3 adults.
According to a study published in the Indian Journal of Medical Research in 2018, the estimated prevalence of prediabetes in India is 14%. And this data only includes just those people who have been tested. (Source-How should one tackle prediabetes in India?)
According to a survey by National Health of India and National Center of Biotechnology Information, 70.5% of pre-diabetes cases were found in 25–44 age.
While 40% and 51.4% of diabetes cases were found in 25–44 and 45–60 aged individuals, respectively. Pre-diabetes is more prevalent in middle age (25–44 age group) and diabetes in 45–60 age group.
The prevalence of prediabetes is growing worldwide, and authorities have estimated that more than 470 million people will have prediabetes by 2030 (Sethuram K et al.).
Figure: Stages of diabetes
Insulin is a hormone which is produced by the beta-pancreatic cells that helps glucose to enter in your muscle, fat, and liver, and use it for energy.
The insulin resistance occurs when cells in your muscles, fat, and liver do not respond well to insulin. And because of that, blood glucose cannot be used for energy. In turn, your pancreatic cells make more insulin to help glucose enter your cells.
If your body becomes insulin resistant, this is what happens:
Figure: Insulin Resistance cycle
(Image source: Insulin Resistance: Causes, Symptoms, Prevention – This silent condition increases your risk of diabetes, heart attacks, and more)
If this insulin resistance occurs for a long time, it may develop into prediabetes.
Pre-diabetes is also called borderline diabetes. Because it is at the verge of becoming diabetes mellitus but can be reversed if right measures are taken beforehand.
The most important thing about prediabetes is that it is reversible. You can prevent or delay prediabetes from developing into diabetes with a change in your lifestyle.
It is a serious condition and if not treated, then it can develop into diabetes.
Figure: Pre-diabetes cycle
(Image Source- The Stages of Diabetes: A Guide)
Diabetes is a group of disorders, characterized by high blood glucose concentrations resulting in insulin secretion, insulin action or both. In other words, hyperglycemia develops gradually due to a progressive loss of beta-cell insulin secretion with insulin resistance.
If your blood sugar levels are too high for a long time, then it can lead to serious health problems including heart, nerve, kidney, eye damage and more.
It affects the microvascular and macrovascular of your bodies.
Diabetes is an important risk factor for Microvascular diseases affecting small blood vessels: retinopathy, nephropathy and neuropathy.
Diabetic retinopathy is the diabetic eye disease which includes all disorders of the retina caused by diabetes. It is the leading cause of blindness in people with diabetes and silent complication with no initial symptoms.
But when symptoms occur, treatment is more complicated and often impossible.
Diabetic nephropathy is a condition caused by damage to the filtering system of the kidneys.
In severe cases, it can lead to kidney failure. The long standing diabetic nephropathy can lead to Chronic kidney disease (CKD).
Figure: This cycle shows how Chronic Renal Failure occurs due to diabetes.
(Source: http://www.idf.org/diabetes-education-modules)
Diabetic neuropathy is a group of nerve disorders caused by diabetes. It causes numbness and sometimes pain and weakness in the hands, arms, feet and legs. Longer the duration of diabetes, the greater the risk.
Diabetes is an important risk factor for Macrovascular diseases affecting large blood vessels: Cardiovascular disease (CVD), Cerebrovascular disease, Peripheral vascular disease (PVD).
CVD complications are one of the most common causes of morbidity and mortality in people with diabetes.
Coronary Artery Disease, stroke and Peripheral Vascular Disease are increased by 2 to 4-fold in people with diabetes.
Symptoms include chest pain, chest tightness, chest pressure and chest discomfort (angina), shortness of breath. It also include pain, numbness, weakness or coldness in your legs or arms if the narrow blood vessels are present.
Cerebrovascular diseases can occur due to sudden narrowing or occlusion of brain blood vessels.
Symptoms include sudden weakness or numbness of face, arm, leg on one side of the body, sudden confusion, sudden dizziness, loss of balance, visual impairment and sudden severe headache.
PVD is defined as the reduced blood supply due to occlusion/narrowing of peripheral blood vessels. It is a risk factor for diabetic foot amputations.
Symptoms include pain on doing any activity, calf pain, numbness in hands and feet.
Liver is a multi-functional organ. One of the liver’s many jobs is regulating blood sugar, but fat in the liver makes that organ less responsive to insulin. In turn, leaves too much glucose in the blood, which can lead to type diabetes.
Diabetes raises your odds of having a more severe form of Non-Alcoholic Fatty Liver Disease, also known as nonalcoholic steatohepatitis (NASH). Fatty liver disease itself usually causes no symptoms. But it raises the risk of developing liver inflammation or scarring (cirrhosis).
It’s also linked to an high risk of liver cancer, heart disease and kidney disease.
In 2014, 8.5% of adults aged 18 years and older had diabetes. In 2019, diabetes was the direct cause of 1.5 million deaths and 48% of all deaths due to diabetes occurred before the age of 70 years. Both types of diabetes can also lead to other long-term complications, like kidney disease, that may result in premature death. Problems like vision loss, nerve damage and infections that may lead to amputations can increase the likelihood of injuries and accidents.
Between 2000 and 2016, there was a 5% increase in premature mortality rates (i.e. before the age of 70) from diabetes.
(Source-https://www.who.int/news-room/fact-sheets/detail/diabetes ).
People who have genetic or lifestyle risk factors are more likely to develop insulin resistance or prediabetes. These risk factors include
People who have metabolic syndrome—a combination of high blood pressure, abnormal cholesterol levels, and large waist size—are more likely to have prediabetes.
To test for prediabetes, these 2 tests are the most important:
You would be diagnosed with prediabetes if:
Figure: Pre-diabetes diagnostic test and criteria
(Image source: Recommended Tests for Identifying Prediabetes | NIDDK)
There is a HOMA-IR test that determines if there is insulin resistance or not.
HOMA-IR stands for Homeostatic Model Assessment of Insulin Resistance or Pre-diabetes. It is an index which determines if a patient has insulin resistance. The blood tests like HbA1C or fasting sugar (glucose) levels may be normal, but if the insulin levels are high, this means that your body may be struggling to maintain normal blood sugar levels. This may be the precursor to diabetes.
Your results from the HOMA-IR test are displayed against a reference scale or range that determines the level of your insulin resistance.
Low HOMA-IR implies that you are sensitive to insulin. On the other hand, higher levels indicate insulin resistance and higher chances of you developing diabetes.
Interpretations of HOMA-IR lab test:
Labs from where you can get your HOMA-IR test done:
TATA 1 mg: HOMA IR C – PEPTIDE MODEL : Purpose & Normal Range of Results | 1mg
Apollo 24×7: Homa IR Test – Price, Procedure, Preparation, Range – Apollo 24|7
Lal path lab: homa-ir ; insulin resistance index
It is possible to reverse the insulin resistance or prediabetes if diagnosed early. You can achieve it through lifestyle changes such as diet and exercise.
In other words, taking small steps, such as eating healthier foods and moving more to lose weight, can help reverse insulin resistance. Also, prevent or delay type 2 diabetes in people with prediabetes.
Don’t rely on dieting or exercise alone: In one University of New Mexico School of Medicine study, published in the International Journal of Obesity, overweight people who lost 10% of their weight through diet plus exercise saw insulin sensitivity improve by an impressive 80%. Those who lost the same amount of weight through diet alone got a 38% increase.
The most important thing to consider when choosing foods to incorporate into diet is to aim for balance, variety, and moderation. Your goal should be to adopt an eating pattern that is sustainable and that you can stick with long-term, while still incorporating foods you enjoy.
Clinical guidelines from the American Diabetes Association suggest exercising for at least 30 minutes a day, five days a week. If you have a strong family history of type 2 diabetes, it might be best to take it up a notch to 45 to 60 minutes a day.
Furthermore, losing as little as 5 to 10 percent of body fat can improve your blood sugar level and help reverse prediabetes.
Stop smoking:
Everyone knows that smoking increases the risk for heart disease and lung cancer. But smoking is also a risk factor for insulin resistance, prediabetes, and type 2 diabetes. So, quitting smoking is the best idea to reverse insulin resistance and prediabetes.
Get proper sleep everyday:
In a study presented at the 2015 meeting of the Obesity Society, researchers found that just one night of sleep deprivation boosted insulin resistance as much as eating high-fat foods for six months. So, get at least 8 hours of sleep for a better insulin production and usage by your cells.
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