New Delhi: Prediabetes is not only a precursor to diabetes, but also a risk factor for cardiovascular diseases such as heart attacks and stroke, say medical experts. Which is why it is important to identify and manage the condition before it progresses to diabetes.
And a study published in The Lancet journal last month has only increased the urgency of addressing the problem in India.
According to the ICMR-IndiaB study by the Indian Council of Medical Research and Madras Diabetes Research Foundation, 101 million people in India suffer from diabetes and 136 million people from prediabetes.
The figures cited in the study show the country’s deepening diabetes crisis and also highlight how a large number of people are on the verge of getting the life-altering metabolic disease, but may also be in a position to avoid it.
According to Dr Sachin Kumar Jain, head of the department of endocrinology, Amrita Hospital, Faridabad, prediabetes is a condition where blood glucose levels are higher than normal, but not high enough to be diagnosed as diabetes. It is a warning sign that indicates a high risk of developing diabetes in the future, if not controlled, he added.
While the Indian government has a health programme to address and control chronic non-communicable diseases, especially cancer, diabetes, cardiovascular diseases and stroke, through the National Health Mission, the programme does not single out prediabetes as a concern.
The study published in The Lancet, which surveyed 1,13,043 individuals across 31 states and Union Territories between 2008 and 2020, showed that there are significant variations in the prevalence of diabetes and prediabetes across different regions of the country.
According to the study, while some states, especially in the south, such as Tamil Nadu and Kerala, have reached a saturation point in their diabetes epidemic and have seen a decline in their prediabetes rates, others have low rates of diabetes but high rates of prediabetes.
These states include Arunachal Pradesh, Uttar Pradesh, Bihar, Madhya Pradesh, Meghalaya, Chhattisgarh, Rajasthan, Sikkim, and Uttar Pradesh, it added. The study also showed that the prevalence of prediabetes is higher in these states compared with others.
“These are the states where rapid conversion of prediabetes to diabetes can be anticipated and regular screening and advice to prevent or reverse diabetes should be the priority,” diabetologist Dr V. Mohan, who is also one of the authors of the IndiaB study, told ThePrint.
Although the exact reason behind prediabetes remains uncertain, family history and genetic factors significantly contribute to its development, he added.
The risk factors for prediabetes include obesity, increased waistline, physical inactivity, advancing age, and a family history of diabetes (including parents and siblings), Jain told ThePrint.
According to Dr Arbinder Singal, CEO and Co-Founder, Fitterfly, a health tech start-up that focuses on diabetes care, because of failure in capturing day-to-day sugar levels, diagnosis of prediabetes is often missed.
He also suggested ways to fight prediabetes and pointed out that it was essential to establish a strong network of lifestyle clinics and use technology-driven solutions.
“Digital therapeutic programmes can fill this gap and make lifestyle interventions accessible and meaningful in regions with high variability,” said Singal.
Also Read: Lancet study points to changing diabetes trends in India — on the rise in villages and among youth
What is prediabetes?
According to Jain, prediabetes refers to blood glucose levels that are higher than the normal range, but below the diagnostic threshold for diabetes mellitus. It encompasses impaired fasting glucose (IFG) and impaired postprandial (after-meal) glucose (IGT) levels.
Normally, fasting blood glucose levels should be below 100 mg/dL and two hours postprandial (after-meal) levels should be below 140 mg/dL, he explained.
However, if the fasting blood glucose level falls between 100 and 125 mg/dl and/or two hours postprandial is between 140 and 199 mg/dL or the HbA1C (glycated haemoglobin) level is between 5.7 and 6.4 percent, it indicates a diagnosis of prediabetes, Jain added.
On the other hand, diabetes is diagnosed when the fasting blood glucose level is 126 mg/dL or higher, the two-hour postprandial glucose level is 200 mg/dL or higher, or HbA1C level is 6.5 percent or higher, he added.
According to Mohan, who is also the chairman and chief diabetologist at Dr Mohan’s Diabetes Specialities Centre, Chennai, those who have combined IFG and IGT tend to progress faster to diabetes.
Prediabetes usually does not cause any specific symptoms or signs, Jain explained, adding, however, that some people may notice darkening of the skin in areas such as the neck, armpits and groin, which is called Acanthosis Nigricansor.
Prediabetes patients also frequently experience fluctuations in sugar levels, with highs exceeding the baseline by more than 60 points and lows dropping 20 points below it, Singal said. These fluctuations can result from unhealthy lifestyle habits and poor food choices, causing spikes in blood sugar levels, he added.
According to Singal, Asians are more prone to developing prediabetes. Moreover, in women, if there is a history of gestational diabetes — diabetes during pregnancy — or if they have polycystic ovarian disease (PCOD), they are predisposed to develop prediabetes, he said.
How to prevent prediabetes?
Prediabetes is crucial not only because it’s a precursor to diabetes, but also because it predisposes people to cardiovascular diseases like heart attacks and stroke, Mohan told ThePrint.
“So apart from controlling one’s blood glucose levels, if the blood pressure or cholesterol (lipid profile) are abnormal, these need to be controlled as well. In fact, it gives patients a golden opportunity to prevent diabetes in the future,” he added.
Several studies, including those from India, have shown that by lifestyle modification, that is diet, exercise and weight reduction where relevant, pre-diabetes can revert to normal and can be prevented from progressing to the diabetes stage.
For Indians this would mean reducing the intake of calories (especially carbohydrates), increasing the intake of protein and fibre in the diet and adding a lot of non-starchy green leafy vegetables as well as some fruit in the diet, Mohan said.
“Exercise is also important; it is very important to have a regular walk or jog or swim at least five to six days a week,” the diabetologist said. “Muscle-building exercises also called resistance training, are also important,” Mohan emphasised.
But all the necessary steps that the country needs to take to tackle the burden of prediabetes are not necessarily at the individual level. For instance, Singal said that to tackle this challenge effectively, it is essential to establish a strong network of lifestyle clinics and use technology-driven solutions.
“By leveraging constant glucose monitoring devices to gather individual data, personalised dietary modifications and behaviour change recommendations can be provided, leading to tailored therapies,” he added.
(Edited by Richa Mishra)
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