The importance of early diagnosis of pre-diabetes

Pre-diabetes is a condition when someone has higher than average blood glucose levels that aren’t quite high enough to be diagnosed with type 2 diabetes. It is thought at least 1.7million Australians have it.

But what are those levels? What is considered a higher than average?

Recently published research in the British Medical Journal looked into assessing cut-off levels for pre-diabetes diagnosis, as there is considerable difference between guidelines around the globe for the lower cut-off point.¹

Pre-diabetes is diagnosed when blood HbA1c levels are raised, or either or both impaired fasting glucose or impaired glucose tolerance are found though blood glucose is not high enough for a type 2 diabetes diagnosis.

In Australia, impaired fasting glucose is diagnosed when fasting glucose is between 6.1-7mmol/L and blood glucose is less than 7.8mmol/L 2 hours after consuming a glucose drink. Impaired glucose tolerance is diagnosed when blood glucose is between 7.8-11mmol/L 2 hours after consuming a glucose drink.² This is in line with the World Health Organisation (WHO) guidelines.³

However, though the impaired glucose tolerance range remains the same, the American Diabetes Association recommends a lower fasting blood glucose cut-off of 5.6-6.9 mmol/L.⁴

But, would a defining lower range be helpful in managing the high blood glucose levels before they climb even higher?

Left untreated, pre-diabetes can easily progress, and it is thought 70% of pre-diabetic individuals will eventually develop type 2 diabetes.⁵

In addition, the research published in the British Medical Journal found pre-diabetes was associated with greater risk of cardiovascular disease and all-cause mortality.¹

This is in people with fasting blood glucose as low 5.6 mmol/L. This is the lower cut-off point as per the American Diabetes Association, but not the WHO or in Australia. Raised HbA1c was also associated with increased risk for cardiovascular disease and coronary artery disease.¹

The importance of all this, you see, is the earlier the diagnosis, the easier it is reverse the condition or curb development into full-blown type 2 diabetes.

Risk factors for pre-diabetes include poor diet, smoking, low physical activity, being overweight, stress, history of gestational diabetes, and family history of diabetes, and some cultures are more sensitive to developing insulin resistance.

Yet, 40-70% of cases of pre-diabetes can be reversed with diet and lifestyle amendments.⁶

Making changes

Food choice, not over-eating, managing stress, and moving every day play a huge role in short and long-term health outcomes, and such amendments could be positive for managing blood glucose, as well as many aspects of health!

These can include:

• Focusing on eating mostly real whole foods, enjoying a heap of vegetables, some healthy fats, and limiting sugar-sweetened beverages, deep fried foods and trans-fats, and heavily processed and refined carbohydrates.
• Being mindful of to stop eating before you are stuffed, eating slowly, and not mistaking hunger for thirst.
• Changing the stressful situation or your response to it, and undertaking activities like mediation, yoga, and spending time with family and friends.
• Brisk walking or some physical activity at least 20minutes a day.

However, each person is different, with different pre-disposition, socio-cultural factors, everyday demands, and can respond differently to various aspects of diet and lifestyle changes. If you have concerns, please consult with your trusted healthcare practitioner to work with you on your individual situation that works for you and your body.

Even if the cut-off points are not changed any time soon, understand that if your levels are slightly elevated, you can take measures to manage it. And it seems the sooner, the better 🙂

By Angela Johnson (BHSc Nut. Med.)

References:

1. Huang, Y et. al. 2016, ‘Association between prediabetes and risk of cardiovascular disease and all cause mortality: systematic review and meta-analysis, British Medical Journal, vol. 355.
2. Diabetes Australia 2015, Pre-diabetes, viewed 30 November 2016, <https://www.diabetesaustralia.com.au/pre-diabetes>
3. World Health Organization 2006, ‘Definition and diagnosis of diabetes mellitus and intermediate hyperglycaemia, viewed 30 November 2016, <http://apps.who.int/iris/bitstream/10665/43588/1/9241594934_eng.pdf>
4. American Diabetes Association 2016, Diagnosing Diabetes and Learning About Prediabetes, viewed 30 November 2016, <http://www.diabetes.org/diabetes-basics/diagnosis/>
5. Eikenberg, JD, & Davy, BM 2013, ‘Prediabetes: A Prevalent and Treatable, but Often Unrecognized, Clinical Condition’, Journal of the Academy of Nutrition & Dietetics, vol. 113, no. 2, pp. 213-218.
6. Bansal, N 2015 ‘Prediabetes diagnosis and treatment: A review’, World Journal of Diabetes, 6, no. 2, pp. 296-303.