Date post: | 18-Nov-2014 |
Category: |
Health & Medicine |
Upload: | dr-awadhesh-sharmadr-ram-manoher-lohia-hospital-new-delhi |
View: | 1,650 times |
Download: | 2 times |
Dr. Awadhesh Sharma
What is pre-diabetes?
Pre-diabetes is a condition where blood sugar levels are higher than normal, but not yet high enough to be diagnosed as diabetes.
Pre-diabetes is a key factor in the development of type 2 diabetes. However, not everyone with pre-diabetes goes on to develop type 2 diabetes.
Pre-diabetes is characterized by disturbance in blood sugar levels as measured by impaired glucose tolerance (IGT) or impaired fasting glucose (IFG). Patients can have one or both of these conditions to be considered pre-diabetic.
Global Burden
Worldwide, 230 million people have diabetes and in 2003, more than 300 million people were estimated to have pre-diabetes. By 2025, it is estimated that approximately 500 million people will have pre-diabetes.
Southeast Asia currently has the highest number of people with pre-diabetes. By 2025, it is estimated that Southeast Asia will continue to have the highest prevalence of pre-diabetes (13.5 percent), followed by Europe (10.9 percent).
Diagnosis Criteria
• One test is not enough!• The diagnosis must be done by a physician.
Normal Pre diabetes
Diabetes
Fasting Blood Glucose Test (FBG)*
Less than100
Between 100 - 125
More than or equal
to 126
Glucose Tolerance Test (GTT) **
Less than 140
Equal to or more than 140 but
less than 200
More than or equal to 200
* FBG blood test is done after fasting 8 hours.
** GTT results are repeated after 2 hours. A person drinks a 75 mg glucose solution before test. 100 mg for Pregnant women.
Why We Worry About Prediabetes?
• Predicts high risk for development of diabetes
• Predicts high risk for development of
atherosclerotic vascular disease
• Both are largely preventable through lifestyle and
pharmacologic interventions
Risk of Cardiovascular Disease Is Elevated Prior to Diagnosis of T2DM
6.00
12.00
18
27
0.00
5.00
10.00
15.00
20.00
25.00
30.00
Normal IGT New DM Previous DM
% w
ith
CV
D
*MI=myocardial infarction.
Adapted from: Hu F, et al. Diabetes Care. 2002;25:1129-1134.
Does everyone with pre-diabetes develop type 2 diabetes?
Although people with pre-diabetes are at an increased risk for
developing type 2 diabetes, not everyone goes on to develop
the disease.
Large clinical outcomes trials have demonstrated that:
Between 29 percent and 55 percent of people with pre-diabetes
develop type 2 diabetes over the course of three years.
In other trials of longer duration, these rates increased to
between 43 percent and 68 percent over six years.
Symptoms of Prediabetes
• Symptoms of diabetes appear when the levels of glucose are either very high or very low.
• Many persons with diabetes and all those with pre-diabetes do not have symptoms.
• The most common symptoms are:
o Fatigue, tiredness or lack of energy
o Excessive constant thirst or hunger
o Frequent need to urinate
o Skin wounds that do not heal or heal very slowly
o Blurred vision
Risk Factors for the Development of S Prediabetes
• Family history of diabetes
• Class of obesity
– Especially central
• Hypertension
• High triglycerides
• Low HDL-C
• Elevated glucose
• Ethnicity other than Caucasian
• Vascular disease• History of gestational
diabetes• History of baby weighing > 9
lbs• Sedentary lifestyle
RISK FACTORS THAT CAN BE MODIFIED
Overweight and obesity
Sedentary lifestyle
An increase of lipids (fats) in the blood
High blood pressure
NON-MODIFIABLE RISK FACTORS
Increasing age
Family History: Inheritance
Background of Gestational diabetes
Race/Ethnic group
Body Mass Index (BMI)
18.5 - 24.9 = NORMAL
25 - 29.9 = OVERWEIGHT
30 & MORE = OBESITY
•Persons with BMI >25 have risk of Diabetes
• BMI combines height and weight measurements
• Read the result in a BMI chart.
The normal values are:• WOMEN = 34” or 95 CM
• MEN= 37” or 100 CM
HIGHER VALUES = HIGH
RISK OF DIABETES
Waist Circumference (WC) It is a simple measurement at waist level
Sedentary Lifestyles
•Lack of exercise
•The comforts of modern living
Increase of Lipids (Fats) in the Blood
A person is at risk of developing diabetes if,•The levels of HDL are low•The levels of LDL are high•The levels of TRIGLYCERIDES are high
Lipids Normal ValuesTotal Cholesterol
Less than 200 mg/dl
• LDL cholesterol
Less than 100 mg/dl
• HDL cholesterol
Men: Higher than 45 mg/dl Women: Higher than 55 mg/dl
Triglycerides Less than 150 mg/dl
High Blood Pressure
A person is at risk of developing diabetes if blood pressure is 140/90 mm Hg or more.
A person with diabetes has more risk of complications if blood pressure is 130/80 mm Hg or more.
Aims and objectives To study microvascular and
macrovascular complications in prediabetes
Material & Methods The study entitled “Study of Microvascular & Macrovascular
Complications in Prediabetics (Impaired Glucose Tolerance)”
was conducted in the department of Medicine of M.L.B.
Medical College, Jhansi from the period of June 2006 to
September 2009. The cases were patients coming to
Medicine OPD and in the emergency being admitted in the
Medicine ward as cases of impaired glucose tolerance or
prediabetes.
Fifty patients of prediabetes were included in the study
which are selected from Medicine OPD and those who
admitted in the Medicine ward.
Distribution of cases according to sex
Male80%
Female20%
0
3
6
9
12
15
18
21
No
. o
f ca
ses
20-29 30-39 40-49 50-59 60-69 70-79
Age (in years)
Distribution of cases according to age
0
5
10
15
20
No
. o
f ca
ses
40-49 50-59 60-69 70-79 80-89
Weight (in Kg)
Distribution of cases according to Weight
0
5
10
15
20
25
No
. o
f ca
ses
140-149 150-159 160-169 170-179
Height (in cm)
Distribution of cases according to Height
Distribution of cases according to risk factors (Hypertension)
20%
80%
Hypertensive Non Hypertensive
Distribution of cases according to risk factors (Dyslipidemia)
40%
60%
Dyslipidemia Normal
0123456789
10111213
No
. o
f cases
Hypercholesterolemia
Increaesd LDL Decreased HDL IncreasedTriglyceride
Type
Distribution of cases according to type of dyslipidemia
Distribution of cases according to risk factors (Obesity)
30%
70%
Obese Normal
Distribution of cases according to type of BMI
16%
10% 2% 2%
70%
Preobese Obese class I Obese class II Obese class IV Other
Distribution of central obesity according to sex
34%
16%
50%
Male Female Without central obesity
Distribution of cases according to risk factors (Smoking)
56%
44%
Smoker Non smoker
Distribution of cases according to risk factors (Family H/o diabetes)
60%
40%
Family H/o Diabetes No family H/o diabetes
Macrovascular complications in prediabetics
16%
20%
6%8% 8% 2%
40%
Progression to frank diabetes Cardiovascular
Cerebrovascular Peripheral vascular disease
Retinopathy Nephropathy
Normal without complications
Macrovascular complications at the time of presentation (Cardiovascular)
4%4%
12%
80%
Stable Angina NSTEMI Unstable Others
Macrovascular complications at the time of presentation (Cerebrovascular)
2%4%
94%
TIA Ischemic episode Others
ResultsThe following conclusions can be drawn from the present study :-
1. Annual progression to diabetes inprediabetics was 5% per year.
2. Majority of them (prediabetics) suffered from cardiovascular complications i.e. 20%.
3. Incidence of cerebrovascular complications is 6%.
4. Incidence of peripheral vascular disease is 8%.
5. Incidence of retinopathy is 8%.
6. Incidence of nephropathy in the form of microalbuminuria is 4%.
7. Incidence of complications is more in subjects having multiple risk factors.
Health
Physical ActivityPhysical Activity
++
Sound NutritionSound Nutrition
Good HealthGood Health
HealthThe first part of our equation is
activityGet moving, find something you enjoy
HealthThe second part of the equation is
nutrition Your body needs the right fuel to help it work
well.
How Can You Help Reduce Your Risk of Diabetes?
Eat foods low
in fat & calories.
If overweight,
lose weight. Physical activity
Stop smoking!
Limit alcohol to 1-2 drinks per day.
Take your medications regularly.
Encourage people to change habits.
Use the pyramid guide to educate people to eat healthy.
Is drug therapy useful in patients with pre-diabetes?
Drug therapy is not recommended by the ADA due to the limited
efficacy of treatment versus lifestyle modification, potential for
adverse drug reactions, lack of data supporting reduction of
microvascular or macrovascular complications of diabetes in this
patient population, and insufficient assessment of the cost-
effectiveness of drug treatment. However, not all patients are able
to implement lifestyle modifications due to physical or other
limitations, and based on limited data available, drug therapy may
be a reasonable option to delay onset of type 2 diabetes and provide
a cardiovascular benefit (TRIPOD and STOP-NIDDM data).
THANK YOU