The Diabetes Risk: Know all about prediabetes & how to reverse it

How big is the pre-diabetic pandemic among the Indian population?
The prevalence of prediabetes in India is often under-estimated. Based on the research studies done in India, among the population that has been tested, the prevalence of prediabetes in India is estimated to be around 15%. Given that almost one in six of Indian adults have prediabetes, no wonder it is considered as an epidemic.

Is there any particular age group or demographic profile that is at risk?
Here are the risk factors for prediabetes:
– Being overweight
– Age 45 years or older
– Having a parent, brother or sister with type 2 diabetes
– Inadequate physically activity (less than thrice a week)
– History of gestational diabetes
(diabetes during pregnancy)
– History of polycystic ovary syndrome.
Please advise on screening and frequency to check pre-diabetes.
Screening is necessary in the following group of people
– Age=45 years without other risk factors
– Family history of type 2 diabetes
– Overweight or obese
– Sedentary lifestyle
– Low good cholesterol or high triglycerides
– Polycystic ovary syndrome
– Fatty liver disease
– History of gestational diabetes or delivery of a baby weighing over 4 kg.

Screening can be done with fasting glucose and HbA1c (8 week average blood sugar level) or oral glucose tolerance test. In the event of normal results, repeat testing is recommended at least every 3 years. In certain individuals with more than two risk factors, more frequent screening may be considered.

Is prediabetes reversible?
Yes, absolutely. Prediabetes and type 2 diabetes mellitus are lifestyle-related diseases and, therefore, dietary changes, adequate physical activity and a moderate amount of weight loss can prevent and reverse prediabetes. Regular physical activity of 150 minutes of walking is considered adequate. A moderate weight loss of about 6 to 10% can achieve reversal of prediabetes.

In what cases can it advance to diabetes?
Prediabetes will progress to overt type 2 diabetes in approximately 25% of subjects within 3–5 years, and as many as 70% of individuals with prediabetes will develop overt diabetes within their lifetime. If the above reversible risk factors are not addressed (inadequate physical activity, progressive weight gain), then such individuals can progress to develop overt diabetes.

Are lifestyle changes enough to reverse early diabetes?
Research has showed that people with early type 2 diabetes can reverse it through diet and lifestyle modifications alone. A study that had people aim for 10,000 steps a day and at least 2 1/2 hours of moderate exercise a week — along with cutting 500-750 calories a day showed that many patients with early type 2 diabetes can bring their blood glucose into normal range without medications. However, this may not be achievable in every individual with type 2 diabetes.

Five points to keep diabetes at bay:
(i) Lose extra weight: Achieve ideal body weight; in people who are overweight or obese, losing at least 6 to 10% of the current body weight
(ii) Be physically more active: Thirty minutes or more of moderate to vigorous aerobic exercise (walking, cycling, swimming); resistance exercises two to three times a week (weightlifting, yoga)
(iii) Follow healthy eating habits: Avoid high carbohydrate diet, avoid refined sugars, increase fibre intake, regular consumption of fresh fruits and vegetables
(iv) Quit smoking: This has been shown to be a risk factor for developing type 2 diabetes
(v) Screening early in at-risk population and taking necessary preventive actions if any parameters suggest progression towards diabetes (for instance, impaired fasting glucose levels, low level of good cholesterol, high triglycerides).

Dr NK Narayanan is
senior consultant, endocrinologist,
Apollo Hospitals, Chennai
BLURB: Dietary changes, physical activity & weight loss
can prevent prediabetes &
type 2 diabetes mellitus