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

WHY WORRY ABOUT PREDIABETES?
o Predicts high risk for development of diabetes.
o Predicts high risk for development of atherosclerotic vascular disease.
o Both (IGT & IFG) are largely preventable through lifestyle and pharmacological interventions.
o Relative risk (RR) of prediabetics in developing frank Diabetes Mellitus (DM) after 10 years of diagnosis are as follows:
NGT -----> RR = 1
IGT ------> RR = 3.2
IFG ------> RR = 3.1
(IGT + IFG) ------> RR = 4.9

IMPAIRED GLUCOSE TOLERANCE (IGT)

Natural history of IGT ------ AFTER 10 YEARS ------------------> 25% will be normoglycemic
25% remain as IGT
50% will turn to DM Type2

PREDICTION OF CONVERSION OF IGT TO Type 2 DM:

HOORN Study:
 Prospective study in subjects with IGT followed for a mean period of 3 years.
 2h Post Glucose and not FPG was the most important predictor of conversion
to NIDDM. DIABETOLOGIA 1996; 39:113-18

ANALYSIS OF 6 STUDIES REVEAL 2h Post Glucose VALUE IS THE MOST IMPORTANT PREDICTOR OF CONVERSION. DIABETES 1997; 40:701-10

ADA RECOMMENDATION FOR SCREENING

 Men & women ≥ 45 years of age with BMI ≥ 25.
 Younger than 45, overweight PLUS 1 or more risk factor.
 If positive, follow up test next day to confirm diagnosis.
 Prediabetics should be monitored every year for type.
 Normal screening results should be retested every 3 years.

NOVEL DIAGNOSTIC MARKER
Spy Diabetes Early
Warning in Eyes.
 Retinal Emission - Flavoprotein autofluoroscense
 Increased level of FA can predict diabetes. [July 15th The Telegraph; University Of Michigan; Kellog Eye Centre ]

TREATMENT RECOMMENDATION FOR PREDIABETES

POPULATION TREATMENT

1. IGT or IFG Life Style Modification (Wt. Loss 5-10%, Exercise >30min/day weekly)
2. IGT + IFG + Any of the following Life Style Modification and/or Metformin 850 mg/day
a) Age <>/= 35 kg/m2
c) F/H of DM IN 1st degree Relative
d) Elevated TG/ Reduced HDLc
e) Hypertension
f) HbA1c > 6.0%

NOVEL TARGETS FOR DIABETES PREVENTION

 Aspirin- reduces NF-kB- reduces islet inflammation.
 SALsalate for Type 2 DM can prevent progression of prediabetes to diabetes.
 Cholestyramine can reduce glycemia.
 Weight Control by any means can prevent development of diabetes in a prediabetic.
 Newer agent are HSD-1 Inhibitors.
 Statins may be helpful to reduce vascular outcomes in a prediabetic.
[Diabetes care Vol 31. Number 7, July2008]

CONCLUSION
 Prediabetes & metabolic syndrome extremely prevalent
 Prediabetes + Metabolic syndrome = high risk for diabetes & CVD
 Early detection of IFG/IGT in high risk individuals & interventions to prevent progression to diabetes through Intensive lifestyle changes (Low Calorie Diet, Stop smoking, Reduced alcohol consumption to 12-14 pegs/week, Increased Physical activity + exercise, Behaviour therapy) are effective & should be encouraged
 Effective pharmacological therapies must be identified.