at prediabetes stage we can reverse diabetes

1. Pre-diabetes
Dr B K MISHRA

2. What is pre diabetes?
• Blood glucose levels are higher than normal
but not high enough to be type 2 diabetes
• More likely to develop type 2 diabetes
• May have some diabetes related problems

3. Btps hospital data 2012
• Out of hundred employees (annual medical
check)
• Diabetes-27
• Prediabetes-10
• Hypertension-30
• Hyperlipidemia-13
• IHD-3
• Asthmatic bronchitis-3
• Medically fit-14

4. How to know prediabetics?
• FPG-normal- less than 100mg/dl
• prediabetes 100 to 125mg/dl
• diabetes more than 126mg/dl
• OGTT-over night fast followed by 75gm
glucose 2hr PPBS-lessthan 140mg normal
• prediabetes140 to 199mg
• diabetes more than 200mg/dl
• Hba1c-less than5.6 normal 5.7 to 6.4
prediabetes morethan6.5 diabetes.

5. ADA Diagnostic Criteria:
Normal, Diabetes, and Pre-diabetes
Clinical Practice Recommendations 2010
In the absence of unequivocal hyperglycemia, criteria 1, 2, and 4 should be confirmed by repeat testing.
Parameter Normal Diabetes Pre-diabetes Method
1 Fasting Plasma
Glucose (mg/dl)
<100 ≥126 100–125 No caloric intake
for at least 8 h
2 2-h plasma
glucose on
OGTT (mg/dl)
<140 ≥200 140–199 WHO method: 75
g glucose load
3 Random plasma
glucose (mg/dl)
<140 ≥200 - with classic
symptoms
of hyperglycemia
or crisis
4 A1C
%
<5.7 ≥6.5 5.7 – 6.4 NGSP certified
method
standardized to
the DCCT assay

6. The Epidemic of
Diabetes and Pre-diabetes
• Diabetes: 30 million and increasing.
• Pre-diabetes: 57 million: About 1/4 (22.6%) of
overweight adults aged 45–74 (CDC data)
“What lies beneath…”
http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2007.pdf
http://www.cdc.gov/diabetes/pubs/factsheets/prediabetes.htm

7. Pre-Diabetes in the
Young and the Old
• The diabetogenic process begins early –
low birth weight and poor nutrition
• Diabetes epidemic due to:
-lack of exercise and overweight in
young persons, and
-aging of the population
• Correlation with central obesity, insulin
resistance, glucose intolerance, high
blood pressure , and dyslipidemia –
metabolic syndrome

8. The Metabolic Syndrome:
NCEP ATP III Criteria
(May 2001 Guidelines)
3 of the Following
Risk Factor Defining Level
Abdominal Obesity (waist circumference)
Men >40 inches (102 cm)
Women >35 inches (88 cm)
Triglycerides 150 mg/dL
HDL Cholesterol
Men <40 mg/dL
Women <50 mg/dL
Blood Pressure 130/85 mmHg
Fasting Glucose 110 mg/dL
NCEP ATP III. JAMA.
2001;285:2486-2497.

9. What are the health risks associated
with pre-diabetes?
• Progression to diabetes: on average, 11% of
people with pre-diabetes develop type 2
diabetes each year (DPP)
• Other studies: majority with pre-diabetes
develop type 2 diabetes in 10 years
• Presence of microvascular complications at
onset of diabetes
• 50% higher risk of CVD: CAD and stroke

10. CDC Data
http://www.cdc.gov/diabetes/pubs/factsheets/prediabetes.htm
accessed June 2010
Among adults with pre-diabetes in 2000, the prevalence
of cardiovascular (heart) disease risk factors was high:
94.9% had dyslipidemia (high blood cholesterol);
56.5% had hypertension (high blood pressure);
13.9% had microalbuminuria
16.6% were current smokers

11. Who should get tested for pre-
diabetes?
• Age 45 or older
• Overweight
• Family history of diabetes
• Other risk factors for diabetes or pre-diabetes:
sedentary lifestyle, hypertension, low HDL
cholesterol, high triglycerides, history of gestational
diabetes or giving birth to a baby weighing more
than 4 KG, or belonging to an ethnic or minority
group at high risk for diabetes

12. Acanthosis Nigricans:
a Sign of Insulin Resistance
• Velvety, light-
brown-to-black
discoloration usually
on the neck, axilla,
groin, dorsum of
hands
• May point to PCOS
in females
• Insulin sensitivity
decreases by 30% at
puberty with
compensatory
increase in insulin
secretion

13. How often should be testing done?
• Every 3 years if glucose tolerance is normal
• Every 1-2 years if pre-diabetes is diagnosed

14. What is the Treatment for
Pre-diabetes?
• Pre-diabetes is a serious medical condition!
• It CAN be treated
• TRIALS: Da Qing 1997, Finnish study 2001, DPP 2002:
persons with pre-diabetes can prevent the
development of T2DM by sustained lifestyle changes
• 5-10% reduction in body weight coupled with 30
minutes a day of moderate physical activity
• Reversal of pre-diabetes and return of blood glucose
levels to the normal range is possible

15. DPP: Intensive Lifestyle Changes Reduce the
Risk of Developing Type 2 Diabetes
• 27 centers nationwide (1998-2002)
• Pre-diabetes, av. age 51, BMI 34, 68% women, 45% minority
participants
• Other groups at high risk: >60, women with h/o GDM, first-
degree relative with diabetes
• > 7% loss of body weight and maintenance of weight loss
• Dietary fat goal -- <25% of calories from fat
• Calorie intake goal -- 1200-1800 kcal/day
• > 150 minutes per week of physical activity
Parameter Placebo Metformin
850 mg bid
Lifestyle: diet, exercise,
behavior modification
Weight Loss none 5 lbs 1st yr: 15 lbs, end 10 lbs
Diabetes at 2.8 yrs 11% 7.8% 4.8%

16. ADA Consensus Statement:
Preventive treatment in high-risk
individuals with pre-diabetes
Diabetes Care 2007
In addition to lifestyle modification, the
following individuals should be considered for
treatment with metformin:
-those who have both IFG and IGT, and
-at least one additional risk factor (age <60,
BMI ≥35, FH of diabetes in first degree
relative, elevated TGs, reduced HDL, or A1C
>6%

17. How to prevent prediabetic to
become diabetic
• Weight management
• Correct eating habits
• Regular exercise
• Specialised supplements

20. Weight reduction

21. How to calculate total body fat?

27. High glycemic index food

28. Low glycemic index food

31. Plant source proteins

33. Good lipids

34. Bad fats

35. Good fats

37. Eat plenty of fruits and vegetables

40. The root cause of all menance

53. Kum khao sahi khao aur pachao

54. Bring balance to your life by YOGA
AND MEDITATION

55. Preventive Strategies and Evidence-
based Interventions that make sense
• Changes at the individual level
• Community- and population-based

56. Pharmacologic Treatments for Pre-diabetes
• Since many individuals with pre-diabetes are generally
healthy, benefits of preventive therapy must outweigh any
associated side-effects or risks
• Expense
• None are FDA-approved
Agent Study RRR Side-effects
Metformin
Glucophage
Da Qing,
Finnish, DPP
28% GI
Acarbose
Precose
STOP-NIDDM 25% GI, poor
compliance
Rosiglitazone
Avandia
DREAM 62% Bone loss,
edema, CHF
Orlistat
Xenical, Alli
XENDOS 52-62% GI, poor
compliance