I’m Only Pre-Diabetic, So I’m Still OK, Right?

Not really.

Pre-diabetes occurs when the fasting blood sugar (FBS) is 100 – 125 milligrams/deciliter (mg/dl). FBS is a blood test done after at least eight hours without food. A FBS of ≥ 126 mg/dl diagnoses diabetes. Less than 100 mg/dl is considered normal.

In 2015, 84.1 million, or 33.9% of the U.S. population, had pre-diabetes. In the Philippines, it is estimated that around 5 million adults (5%) have diabetes, and the same number are pre-diabetic. At the current rate, it is projected that there will be more diabetics in the whole world in the coming decades.

But if somebody is only pre-diabetic, what’s the concern? Why care?

Natural History of T2D Complications

Timeline of Diabetes Complications

From the graph, we can see that more than 10 years before the diagnosis of Type 2 or Adult Onset Diabetes, cardiovascular or macrovascular (more than 100 microns in internal diameter) and microvascular complications have already started.

Heart Attacks, Strokes, Gangrene

Macrovascular blood vessels are found in the blood vessels supplying the brain, heart, arms, and legs. These macrovascular injuries can lead to strokes, heart attacks, numbness of the hands and feet, non-healing wounds, and gangrene.

Blindness, Kidney Failure, and Dementia

Microvascular complications (less than 100 microns) eventually manifest as blindness, kidney failure, and dementia. They involve the small blood vessels of the retina, kidneys, and brain. The graphic also shows that the diagnosis and treatment of Type 2 diabetes are usually delayed several years after the onset of diabetes.

In the emergency room, some patients are initially diagnosed with diabetes after complications like severe infections of the foot requiring amputation, a heart attack, or kidney failure.

Several authors coin the term cardiometabolic syndrome because the metabolic syndrome, diabetes, and heart disease are so intertwined that if a patient has diabetes, then it is also assumed that they have heart disease.

Early Control of Blood Sugar Has Long-Lasting Beneficial Effects

The diagnosis of Pre-diabetes is not a death sentence but can be considered as a blessing in disguise. Early detection of an FBS >100 mg/dl is an opportunity for rapid correction and treatment. The Diabetes Control and Complications Trial (DCCT) was done in 1982–1993.

The same study groups (1,441 patients) were followed up by another study called The Epidemiology of Diabetes Interventions and Complications (EDIC) in 1994 – 2013. Both DCCT and EDIC showed that the intensive control of blood sugar to achieve glucose control as healthy as possible in the first 10 years of diabetes resulted in a significant reduction in heart attacks and blindness, kidney failure, and stroke complications.

Take-Home Message of the DCCT/EDIC Studies

Once diagnosed with pre-diabetes/diabetes, early control of your blood sugar as aggressively as possible significantly reduces diabetic complications and also prolongs life.

How to Prevent Diabetes Complications

Early diagnosis. If you are overweight, obese, or have a waistline that measures more than 35 inches (89 centimeters) for women, Asian women 31 inches. More than 40 inches (102 centimeters) for men, Asian men 35 inches.
If the FBS result is more than 100 mg/dl, talk to your physician about lowering your blood sugar. The initial recommendations are diet and exercise.
Intermittent fasting and high-intensity exercises reduce the visceral fat responsible for the increased abdominal girth and the source of pro-inflammatory substances (adipokines) that lead to diabetes, ischemic heart disease, and strokes.
Start a low-carbohydrate diet and stay away from sweets.

Related Readings:

Intermittent Fasting

Diabetes

High-Intensity Interval Training

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