Not yet diabetic, but rapidly getting there. Yes, there is a condition like that, and in India, hand-in-glove with diabetes, it is reaching epidemic proportions.
“The statistics are staggering,” says Chennai-based diabetologist V. Mohan of Dr Mohan’s Diabetes Specialities Centre (DMDSC).
The results of the ICMR-INDIAB (Indian Council of Medical Research—India Diabetes) study released in 2011 for adults aged 20 and above showed that an average of 11% had pre-diabetes in India. The prevalence of pre-diabetes in urban areas was found to be higher (13.2%) than in rural areas (8.5%), says Dr Mohan. “We pegged that in 2011 in India there were 62.4 million people with diabetes and 77.2 million people with pre-diabetes,” says Dr Mohan, who also heads the Madras Diabetes Research Foundation and was the national coordinator for the study.
“What I find scary is that the disease is progressing at an even faster pace than anticipated earlier,” Dr Mohan says. “According to the (International Diabetes Federation’s) Diabetes Atlas of 2009, there were 50.8 million people with diabetes in India and in 2011, in just two years, this figure has gone up by around 12 million (to 62.4 million). We are obviously going to overshoot, exponentially, the earlier projections for the year 2030, by millions.”
While issues about diabetes remain, and work must happen there, “the important thing for us in India is to try and rein in our pre-diabetics”, says Subhash Kumar Wangnoo, senior consultant endocrinologist and diabetologist, Apollo centre for obesity, diabetes and endocrinology (Acode), Indraprastha Apollo Hospitals, Delhi. “Because by the time diabetes gets detected in India, some damage to body organs like the kidneys, eyes, etc., has already begun. And detection usually gets missed because most often there are no symptoms at all with pre-diabetes.”
"In 2004, it was projected that there will be 79.4 million diabetics in 2030 in India. The IDF Diabetes Fourth Atlas (2009) revised those numbers to predict 87 million diabetics by 2030, and according to the fifth atlas, published in 2011, the expected figures are pegged at 101 million diabetics by 2030."
Who is a pre-diabetic?
There are two types of pre-diabetes, says Dr Mohan: “Impaired fasting glucose (IFG), where the fasting plasma glucose is between 100-125 mg/dl (less than 100 mg/dl is considered normal and 126 mg/dl or higher is diabetes) and Impaired glucose tolerance (IGT), which is diagnosed when the 2-hour post-glucose value in the GTT (Glucose Tolerance Test) is between 141-199 mg/dl (a value of 200 mg/dl and above is considered to be diabetes while a value below 140 mg/dl is normal)”. Simply put, a pre-diabetic is a person whose blood glucose levels are higher than normal but not high enough to be classified as diabetes.
“Pre-diabetes is the state characterized by raised fasting and/or post- prandial blood glucose. However, this raised value is less than a criteria for fitting someone into the bracket of diabetes, but at the same time is more than normal fasting or post-prandial blood glucose,” explains Satish Koul, consultant, internal medicine, Columbia Asia, Gurgaon.
“The same factors which precipitate diabetes also precipitate pre-diabetes: genetic (hereditary) predisposition, obesity, physical inactivity, stress,” Dr Mohan adds.
For instance, a 32-year-old doctor came to Dr Wangnoo’s OPD with routine complaints of weakness and inability to concentrate on his work. He had no family history of diabetes, was doing well in his profession, but was unable to find time to sort out his health problems because of his busy schedule. Tests showed his sugar was in the pre-diabetes range and his triglycerides were also elevated. “He agreed to follow a structured regimen to combat the situation and with proper diet and exercise, when he had a follow-up a year later, we found that his sugar and triglycerides were all within limits,” says Dr Wangnoo.
The pre-diabetic stage is reversible—if caught it’s possible to avert diabetes, say the doctors.
“Unfortunately pre-diabetes (and even diabetes at times) is still detected in our country just by chance when a blood sugar test is done to test for specific complaints like organ complications, or fatigue,” says Dr Koul. “That is why regular screening (see “The risk factors”) is essential, as it is only on testing that one can be sure if the sugars are in the normal range or not.”
Dr Koul says the undetected pre-diabetic stage can be dangerous also because it can lead to macrovascular complications that lead to heart attacks. “It takes about 5-10 years for a pre-diabetic to become a full-blown diabetic,” Dr Mohan says.
Gear up for the fight
Moving away from the pre-diabetic precipice is simple in theory, but has proven to be extremely hard in practice because it requires a three-pronged approach: regular exercise, a good diet, and weight management.
“By doing these,” Dr Mohan says, “most people with pre-diabetes can prevent development of diabetes and even turn their blood sugar levels back to the normal range.”
Medicinal intervention (drug therapy) for individuals with pre-diabetes is currently controversial because its cost-effectiveness and safety profile are not known, so lifestyle management is key.
“We strongly encourage pre-diabetics to maintain a normal BMI (body mass index, or the right weight for their height) with regular physical activity,” says Dr Koul. And, he says, “ensure that their lipid profile and blood pressure are maintained at normal range. Also a regular preventive health check (every two years after the age of 30 and every year after the age of 40) is the ideal way to keep a check.”
A 10-year study review published in the journal Lancet in November 2009 reported that diabetes incidence in high-risk adults had come down by 58% with intensive lifestyle intervention compared to 31% in the medication treatment group (the Metformin drug).
Intervention involves keeping the diet in check—having more fibre, vegetables and fruits, cutting down on fat and red meat, opting for wholegrains, keeping alcohol consumption to a low level, and moderate exercise, such as walking 30-45 minutes a day, five days a week.
“Even if you can’t get to your ideal body weight, losing some weight, like 5-10% of your total body weight, can also make a huge difference,” says Dr Koul.
Pre-diabetes is a wake-up call, one that needs to be heeded.
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The risk factors
Regular screening is essential.
u If you are overweight and aged 35 or above, you should get tested for pre-diabetes.
u If your weight is normal and you’re over 35, you should still check with your doctor if you need to be tested for pre-diabetes.
u For adults younger than 35 years and overweight, the doctor may recommend tests for any indicators of, or other risk factors for, diabetes or pre-diabetes, including high blood pressure, low HDL (high-density lipoprotein) and high triglycerides, a family history of diabetes, a history of gestational diabetes (during pregnancy) or giving birth to a baby weighing more than 4kg.
Source—Dr Subhash Kumar Wangnoo.