The results of the first epidemiological study of the prevalence of type 2 diabetes mellitus among the adult population in Russia NATION, which involved more than 26,000 people aged 20 to 79 years from 63 regions of Russia, only confirmed the trend of high prevalence of diabetes mellitus among the population – 19 .3%, which is approximately 20.7 million adults in Russia.
1. What is prediabetes?
Pre-diabetes is characterized by an increase in glucose levels above normal levels, but not yet high enough to diagnose diabetes mellitus. For this reason, prediabetes is often considered a “gray area” between normal blood sugar levels and diabetic levels.
Pre-diabetic conditions, including impaired fasting glycemia (a measure of FGL) or impaired glucose tolerance (a measure of ITG), are associated not only with the risk of developing diabetes mellitus, but also with an increased risk of morbidity and mortality from cardiovascular disease.
To date, there are no general diagnostic criteria for prediabetes. The American Diabetes Association (ADA) defines prediabetes as an increase in fasting glucose levels of 5.6-6.9 mmol/L or an increase in blood glucose levels 2 hours after a glucose tolerance test of 7.8-11.0 mmol/L. Also, in prediabetes, the level of glycated hemoglobin HbA1c is 5.7–6.4%. The World Health Organization (WHO) sets the cut-off value for pre-diabetes LNL at 6.1–6.9 mmol/L. The lower ADA threshold for NGN is based on evidence that a fasting glucose level of about 6.1 mmol/L is associated with a higher risk of micro- and macrovascular complications.
Compared to the current WHO criteria, the application of the ADA criteria results in a two-fold increase in the number of people diagnosed with prediabetes. It’s important to remember that people with prediabetes are at a higher risk of developing type 2 diabetes, with about five to ten percent of such cases per year progressing to type 2 diabetes. Early detection of prediabetes provides the opportunity for correction to prevent or slow down further progression of the condition to type 2 diabetes mellitus.
2. What are the warning signs?
Prediabetes usually does not show any severe symptoms. A person can have prediabetes for many years and be unaware of the problem, attributing intermittent health discomfort to ordinary fatigue or mild malaise.
A possible sign of prediabetes is darkening of the skin in certain parts of the body, in places of friction and skin folds. Affected areas may include neck, armpits, elbows, knees. Also an unfavorable factor is weight gain. The classic options for the transition from prediabetes to type 2 diabetes are increased thirst and dry mouth, frequent urination, especially at night, fatigue, decreased vision.
3. What are the causes of prediabetes?
Prediabetes develops when the ratio of glucose and insulin is disturbed, the main factor is insulin resistance. Insulin is needed to transport glucose as an energy source to cells from the bloodstream. If insulin resistance develops, then the process of glucose utilization by cells is disrupted, which will lead to higher blood glucose levels and the development of prediabetes. The exact cause of prediabetes is unknown. However, there are a number of factors that can cause the development of carbohydrate metabolism disorders. These are the same risk factors associated with the development of type 2 diabetes:
– Body mass. Being overweight or obese (especially around the waist, abdomen) is an important risk factor for developing prediabetes.
– Waist circumference. A large waist circumference may indicate insulin resistance. The risk of insulin resistance increases in men with a waist circumference greater than 100 cm and in women with a waist greater than 88 cm.
– Sedentary lifestyle. The less physical activity, the higher the risk of developing disorders of carbohydrate metabolism. Physical activity helps to control body weight, use glucose in muscles and improves insulin sensitivity of cells.
– Age. Although prediabetes can appear at any age, the risk of developing carbohydrate metabolism disorders increases from the age of 45. This is due to the fact that people from this age tend to reduce physical activity, lose muscle mass and gain weight over the years. And after age 65, the risk increases exponentially.
– Hereditary factor. The risk of developing disorders of carbohydrate metabolism increases in the presence of diabetes in first-line relatives.
– Race, ethnicity. Certain ethnic groups are at greater risk of developing carbohydrate metabolic disorders, including African Americans, Hispanics, Native Americans, and Asian Americans.
– Gestational diabetes. If gestational diabetes is diagnosed during pregnancy, both the woman and the baby have an increased risk of developing prediabetes. Also, a woman who gives birth to a child weighing more than 4 kg is at high risk of developing prediabetes.
– Polycystic ovary syndrome (PCOS). It is a condition characterized by irregular menstruation, hirsutism, and obesity. PCOS increases the risk of developing diabetes in women, as it is associated with insulin resistance.
– Apnea. People with a certain sleep disorder (obstructive sleep apnea) have an increased risk of insulin resistance. People who work shifts or night shifts and have trouble sleeping may also be at increased risk of developing prediabetes or type 2 diabetes.
Other conditions associated with prediabetes:
- Arterial hypertension (≥140/90 mm Hg or antihypertensive therapy) or other cardiovascular diseases
- Low HDL (high-density lipoprotein) cholesterol <35 mgdl (0.90 mmoll) andor elevated triglycerides> 250 mg/dL (2.82 mmol/L)
4. If a person eats a lot of sweets, can he develop prediabetes?
The greatest amount of glucose in the body comes from food, namely from carbohydrates. As mentioned earlier, insulin is produced by the beta cells of the pancreas to lower glycemia. Thanks to insulin, glucose is utilized by the cells of the body, while its concentration in the blood decreases. When blood sugar levels fall, there is a decrease in insulin secretion by the pancreas. However, with prolonged excess intake of simple carbohydrates with food into the body, as well as against the background of adverse risk factors, such as heredity, a sedentary lifestyle, insulin secretion is impaired. In the initial stages, the body adapts to the increased glucose supply by stimulating the production of more insulin (hyperinsulinemia stage), and subsequently the cells become resistant to the action of insulin, insulin resistance develops, which contributes to elevated blood glucose levels and the development of prediabetes.
5. Is prediabetes treatable?
Prediabetes is a reversible condition. Lifestyle modification (proper nutrition, regular exercise, good and healthy sleep) is a fundamental aspect of preventing and preventing the development of prediabetes and the transition from prediabetes to diabetes.
Proper nutrition. Proper nutrition contributes to the achievement and maintenance of target levels of body weight, glycemia, blood pressure and lipid spectrum. Sharp, non-physiological dietary restrictions and fasting are contraindicated. There is no ideal percentage of calories, carbohydrates, proteins and fats for everyone. Therefore, macronutrient distribution should be based on an individualized assessment of current eating patterns, preferences, and metabolic goals. The maximum restriction of fats (primarily of animal origin) and simple sugars is recommended; moderate (in the amount of half the usual portion) – products consisting mainly of complex carbohydrates (starches) and proteins; unlimited consumption – foods with a minimum calorie content (mostly rich in water and fiber, vegetables). A diet rich in vegetables, nuts, whole grains, dairy products, and foods containing mono- and polyunsaturated fatty acids (vegetable oils, fish) is associated with a lower risk of developing prediabetes.
Weight loss and control. Weight control and weight loss is essential for overweight and obese individuals. Losing just 5 to 10% of your original weight can significantly reduce your risk of developing type 2 diabetes. There is strong and progressive evidence that moderate, permanent weight loss can slow the transition from prediabetes to type 2 diabetes.
Regular physical activity. During exercise, the body uses more glucose and requires less insulin to transport glucose, so exercise can reduce glycemia and insulin resistance. Also, physical activity helps to reduce weight, increase the tone of the heart and blood vessels, improve the quality of sleep and mood.
It is recommended to engage in moderate to vigorous aerobic physical activity for at least 150 minutes a week – 30-60 minutes, preferably daily, but at least three times a week.
Metformin. Also, in addition to lifestyle modification, for those at very high risk of developing type 2 diabetes, the addition of pharmacological treatment is recommended. Based on the results of the studies, the drug Metformin is currently the only pharmacological hypoglycemic drug recommended for the prevention of type 2 diabetes mellitus in patients with prediabetes.