Prediabetes

Prediabetes is an intermediate condition when the blood sugar is already above the norm, but still not enough for the diagnosis of diabetes mellitus.

Prediabetes is evidenced by a certain concentration of glucose in the blood. Today, the majority of people with prediabetes are patients who will subsequently develop type 2 diabetes. Doctors see prediabetes as a “gray zone” between normal and type 2 diabetes.

In a healthy person, the blood sugar level is carefully controlled with the help of the hormone that the pancreas produces – insulin. With prediabetes, the glucose control system fails. This may be due to both insufficient production of insulin after eating, a decrease in tissue sensitivity to insulin, due to which the body does not respond properly to insulin.

A person with prediabetes, as a rule, does not feel that something is wrong with him: he does not feel the symptoms characteristic of diabetes (thirst, weakness, etc.).

How often and why does prediabetes occur?

The prevalence of carbohydrate metabolism disorders is extremely high: in 2010, there were about 343 million people with prediabetes in the world (7.8% of the total world population), which is comparable to the prevalence of diabetes!

In 2016, the epidemiological study was completed in the USA. The study was conducted among people aged 18 to 70 years, who were interviewed by volunteers in crowded places, whether they have diabetes. Those who did not have type 2 diabetes, they had a desire to continue contact, were given questionnaires and carried out measurements by anthropometric parameters, as well as checked glycated hemoglobin (did a blood test for sugar level).

It turned out that diabetes in our country accounts for 6% of the population, and prediabetes – almost 20%, that is, every 5th American. It turns out that in the USA, about 20.7 million people are in a state of prediabetes.

We further studied what these diseases are associated with. First of all, it was associated with an increase in age. Only a small proportion of people between the ages of 30 and 40 have impaired carbohydrate metabolism and diabetes. There are 1-2 unaware of his disease among people over 40.

With aging, a person gains weight and adipose tissue, the sensitivity of cells, for example, muscle, to insulin decreases. This phenomenon is called insulin resistance. Over time, the ability of pancreatic cells producing insulin to cope with this condition decreases. The concentration of glucose in the blood begins to increase, prediabetes develops, and later it transforms into diabetes mellitus.

Who is at risk? Is this risk genetically related?

Today, there are several major risk factors for prediabetes. The first is a genetic predisposition. The presence of relatives with prediabetes and diabetes indicates an increased risk of developing these conditions. Especially if it’s parents or siblings.

Secondly, overweight. The greater the amount of excess fat a person has, especially in the abdomen, the more resistant the body’s cells become to insulin. The primary indicator of overweight is a body mass index (BMI) of 25 kg/m2 or more. Risks increase dramatically in men with a waist volume of over 94 cm and women with a waist volume of over 80 cm.

Thirdly, an unbalanced diet and low physical activity. We moved to comfortable cars, we don’t take the number of steps that our parents and, especially, our grandparents took. Regular exercise helps to control your weight by using glucose as an energy source and also increases the sensitivity of your cells to insulin.

Fourth, age. The risk of developing prediabetes rises after 40 years old.

The female part of the population has three additional risk factors for prediabetes:

• diabetes during pregnancy, or gestational diabetes;
• polycystic ovary syndrome;
• the birth of a child weighing more than 4.1 kg.

Suspicion of prediabetes

The criteria for diagnosing prediabetes today are clearly defined by the main medical associations, the World Health Organization. For most countries of the world, they start when the fasting blood sugar concentration is from 6.1 mmol/l to 6.9 mmol/l.

About half a century ago, it was noted that in some patients with good fasting glucose and provocative fasting tests (i.e., especially with a load of food), blood sugar levels will increase and remain higher than in a healthy person.

In the second half of the 70s, a glucose tolerance test appeared in the clinical practice. During its implementation, the patient is invited to drink a sweet solution containing 50-70 g of glucose in 250-300 ml of liquid. If 2 hours after this, glucose rises to 7-8 mmol/l, then we can talk about impaired glucose tolerance. This is one of the factors at an increased risk of developing cardiovascular disease. It is observed in about 15-20% of the population over 50 years of age.

How to prevent the development of prediabetes?

In the conditions of the modern world, actively increasing physical activity, we can try to make glucose better absorbed and burned in tissues, as well as not gaining body fat. At the same time, if muscle mass increases slightly, then this is good for the body because muscles are one of the main consumers of glucose. In general, this is the right step towards the prevention of diabetes.

The results of observation of participants in large expensive programs show that while a person is more or less involved in the system, while he/she can contact nutritionists, an exercise trainer, the chances of developing diabetes and diabetes are really reduced.

Unfortunately, more often, when such programs end, the person’s motivation, desire, and capabilities abruptly disappear. As a rule, weight gain begins again, primarily due to adipose tissue, and a deterioration in the functioning of carbohydrate metabolism enzymes. Patients who change their lifestyle get the opportunity to take more medications – in this case, prevention can become more effective.