“PREDIABETES” – ARE WE IGNORING? (Part -I)

PROLOGUE
British Diabetic Association recommended the use of the term prediabetes only in retrospect in the life of a diabetic before diabetes. WHO replaced this term in 1980’s with statistical risk classes- IGT (Impaired Glucose Tolerance), IFG (Impaired Fasting Glucose). US Secretary of Health Mr.TG Thomson reintroduced the term prediabetes in 2002 & subsequently accepted by ADA and Department of Health and Human Services USA.

DEFINITION
Prediabetes includes persons having IGT (Impaired Glucose Tolerance), IFG (Impaired Fasting Glucose) either isolated or in combination.
• Prediabetes – a condition that raises a person’s risk of developing Type 2 Diabetes, Heart Disease & Stroke. (DHHS US)
• ADA (American Diabetic Association) Practice Guidelines for diagnosis of prediabetes-
1 FBG: 100 – 125 mg/dl
2 OGT: 140 – 199 mg/dl (Oral Glucose Tolerance)

OGTT & PREDIABETES

STATE FPG Level (mg/dl) 2-h plasma glucose in OGTT (mg/dl)
IFG 100-125 <200
Isolated IFG 100-125 <140>IGT <126>

Isolated IGT <100FPG = Fasting Plasma Glucose OGTT = Oral Glucose Tolerance Test]

FALLACY OF THE TERM PREDIABETES

According to Dr. George Alberti at International Congress on Prediabetes 2005, the term “prediabetes” has some serious fallacy as noted below:
 Only 50% prediabetics develop diabetes in 10 years.--- so 50% escapes.
 The definition does not include some people at risk of developing diabetes– like those with strong family history, other normoglycemic risk group, and some ethnic groups.
 Difficulty of communicating to general public about a high-risk situation.



PREVALENCE OF PREDIABETES IN INDIANS

 South India: 14% have IGT (A. Ramchandran; BMJ 1988)
 Prevalence of IGT & IFG are high in India and expected to increase from 85.6 million (2003) to 132 million (by 2025) (A. Ramchandran; Netaji Oration 2005)
 IGT occurs early in Indians. (A. Ramchandran; Netaji Oration 2005)