THERE is a growing epidemic of pre-diabetes in several countries around the world, which has been linked to surging global obesity rates. Many readers will be familiar with frank diabetes, an unrelenting medical condition that is characterised by high levels of sugar in the blood and is associated with damage to various organs in the body including the eyes, heart, kidneys, and brain.Before people develop frank diabetes, they almost always have pre-diabetes, a situation in which blood glucose levels are higher than normal but not yet high enough to be diagnosed as frank diabetes. Pre-diabetes is frequently viewed as the 'gray area' between normal blood sugar and diabetic levels.If a person has pre-diabetes but does not yet have frank diabetes, why should there be any concern about a growing epidemic' Well, 11 per cent of people with pre-diabetes go on to develop frank diabetes each year, 70 per cent of people with pre-diabetes will develop frank diabetes over their lifetime, and emerging research increasingly shows that damage to the organs in the body (listed above) may already be slowly occurring during pre-diabetes.Although there are no figures available on the proportion of Nigerians, who have pre-diabetes, it is estimated that approximately 35 per cent of adults in the United States have pre-diabetes, corresponding to about 79 million people. This number is more than three times the number of people with frank diabetes (26 million people). A major concern is that the overwhelming majority of people with pre-diabetes appear to be unaware of their risk of developing diabetes and potential organ damage, thereby denying themselves the opportunity to prevent both these undesirable processes from happening to them.Currently there are three expert recommended methods for diagnosing pre-diabetes:' Fasting plasma glucose test (FPG). This test requires a person to fast overnight and the blood glucose is measured first thing in the morning before eating. A person is diagnosed with pre-diabetes if the FPG lies between 100 and 125 mg/dl. If the FPG is 126 mg/dl or more, that person has frank diabetes.' Oral glucose tolerance test (OGTT). This requires a person to fast overnight and the blood glucose is checked first after fasting, and then again 2-hours after drinking a glucose-rich drink. A person is diagnosed with pre-diabetes if the 2-hour blood glucose is 140 to 199 mg/dl. If the 2-hour blood glucose is 200 mg/dl or more, that person has frank diabetes.' Glycosylated Hemoglobin (A1C). This test provides information on the average amount of glucose in the blood over the preceding three months. A person is diagnosed with pre-diabetes if the A1C lies between 5.7 per cent-6.4 per cent. If the A1C is 6.5 per cent or more, that person has frank diabetes.In the last week, two important studies on pre-diabetes were published in leading British medical journals. The first, presented an analysis of all the published studies examining the link between pre-diabetes and risk of stroke. It included over three-quarters of a million individuals from around the world. Using sophisticated statistical techniques the analysis showed that having pre-diabetes (not frank diabetes) was associated with a 20 per cent higher risk of future stroke, regardless of age, gender or race.It also revealed that if a person had any impairment of glucose tolerance (that is an abnormal OGTT) they were at significantly higher risk of future stroke, but a person was only at higher risk of stroke if the FPG level was 110 mg/dL or more.AIC levels and stroke risk were not assessed in this study. The second study, observed that people with pre-diabetes who were able to reduce their blood sugar had a 56 per cent reduction in the risk of developing frank diabetes during nearly six years of follow-up regardless of how those normal blood sugar levels were achieved (i.e. whether it was done by adopting a healthy lifestyle or by using a drug called metformin to lower blood sugar).What is the significance of these recent data' Well, it means that the public needs to be better aware of the dangers of pre-diabetes. Certain individuals should have their blood sugar levels regularly checked to determine whether they have pre-diabetes. If they do have pre-diabetes, they should make changes to their lifestyle as soon as possible. Adopting these beneficial lifestyle practices under the supervision of their doctor would considerably lower their risk of developing frank diabetes, and possibly reduce their chances of experiencing a stroke in the future.Table 1.Who should get regularly tested for pre-diabetes'Overweight (i.e. body mass index > 25) and aged 45 years or olderOverweight (i.e. body mass index > 25), aged 44 years or younger, and any one of the following:'High blood pressure'Abnormal cholesterol'Family (parent or sibling) History of diabetes'History of diabetes during pregnancy'History of giving birth to a baby weighing more than 9 pounds (4kg)How often should pre-diabetes be checked'If your blood glucose levels are in the normal range, get checked every three years, or more often if your doctor recommends it.If you have pre-diabetes, you should be checked for frank diabetes every one or two years after you are told you have pre-diabetes.Table 2.Lifestyle Modification ItemDietRestrict salt intake; Ideally no more than 2 grams of sodium per dayIncrease potassium intake; At least 5 servings of fruits and/or vegetables per dayAt least 2 servings of fish per weekAt least 1 fiber-rich meal per dayLess than one-third of daily intake attributable to fat. Less than 7% of day's total calories should be from saturated fat. Red meat in low amounts. No more than 2 egg yolks a week. Low fat milk. Olive oil and Canola oil preferable to other cooking oils.ExerciseModerate or vigorous exercise for 30 minutes at least 4 days per the week.Examples of moderate exercise include walking, running, swimming, gardening and yard work, farming, strenuous housework, cycling, dancing, and tennis. Ideally, exercise activity should make your heart race and induce sweat moderately. Examples of vigorous exercise include walking uphill, construction work and other types of physical labor, basketball, climbing, and soccer.Ideal weightBody mass index is calculated by dividing one's weight in kilograms by the square of one's height in metersIdeal: Body mass index of 18.5 to 24.9 kg/m2Overweight: 25 to 29.9 kg/m2Obese Class I: 30 to 34.9 kg/m2Obese Class II: 35 to 39.9 kg/m2Obese Class III: 40 kg/m2and higherDon't worry if you can't get to your ideal body weight. Losing just 7% of your body weight can lower your risk for frank diabetes (i.e. return blood glucose levels to the normal range).
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