Pre-diabetes: What you need to know

Posted by Specialist Doctor II Nguyen Xuan Thang - Deputy Head of Internal Medicine Department and Head of Internal Medicine Unit - Department of Examination & Internal Medicine - Vinmec Central Park International General Hospital

Pre-diabetes is a medical condition where blood glucose levels are higher than normal but the diagnostic criteria for diabetes are not met. The disease is defined by impaired fasting glucose or impaired glucose tolerance (RLDNG) and/or elevated HbA1c. What are the stages of pre-diabetes?

Pre-diabetes (DM) is a medical condition when blood glucose levels are higher than normal but the diagnostic criteria for diabetes are not met. Accordingly, prediabetes is defined by impaired fasting blood glucose or impaired glucose tolerance (RLDNG) and/or elevated HbA1c. Prediabetes is an intermediate stage between normal people and type 2 diabetes.
Prediabetes is associated with obesity (especially abdominal or visceral fat), dyslipidemia with high triglycerides and/or low HDL cholesterol, and hypertension.

Over the past decade, the incidence and prevalence of type 2 diabetes in children and adolescents has increased significantly, especially among ethnic and minority groups. There are recommendations for risk-based screening for type 2 diabetes or prediabetes in asymptomatic children and adolescents.
More than one-third of the US population has pre-diabetes. Nine out of 10 patients have a pre-diabetes condition that they are not aware of. In Vietnam, according to the report of IDF 2019, the proportion of people with ED accounted for 8.6%, equivalent to 5.3 million people, 1.4 times higher than that of patients with diabetes.

Diagnosis of prediabetes when one of the following disorders is present:

For testing prediabetes and type 2 diabetes, fasting blood glucose, 2 hour blood glucose during 75g oral tolerance test and A1C are equally suitable.

Currently, the rate of prediabetes that progresses to diabetes is recorded as follows:
5-10% of prediabetes will progress to diabetes every year 15 - 30% of prediabetes diabetes can progress to diabetes within 5 years 50% of patients with prediabetes will progress to diabetes within 10 years 70% of patients with prediabetes will progress to diabetes if not treatment. Accordingly, prediabetes increases the risk of cardiovascular events, coronary heart disease, stroke, and death. Therefore, the screening and detection of pre-diabetes management at an early stage is very important.

People who are obese or have one of the following risk factors should be screened for prediabetes:
Have a first-degree relative (parent, sibling, biological child) with diabetes Diabetes History of atherosclerotic cardiovascular disease Hypertension (BP ≥ 140/90 mmHg, or on treatment for hypertension) HDL cholesterol < 35 mg/dL (0.9 mmol/l) and/or triglycerides > 250 mg /dL (2.8mmol/l) Women with polycystic ovary syndrome Physical inactivity Other clinical conditions associated with insulin resistance (eg, severe obesity, acanthosis nigricans)

During pregnancy, if pregnant women are diagnosed with pre-diabetes, long-term monitoring is required, testing at least every 3 years.

According to recommendations, all people 45 years of age and older need to have diabetes screening to detect the risk of disease early.
In addition, screening for prediabetes should also be performed in young adults who are overweight or obese and who have one or more of the following risk factors:
Maternal history of diabetes or diabetes pregnancy during young pregnancy Family history of type 2 diabetes in first- or second-degree relatives Race/ethnicity (Native American, African-American, Latino, Asian-American, People) Pacific Islander) People with signs of insulin resistance or conditions associated with insulin resistance (acanthosis nigricans, hypertension, dyslipidemia, polycystic ovary syndrome or low birth weight for age) pregnancy) Definition of “young person”: After the onset of puberty or after the age of 10, whichever is earlier. If tests are normal, testing should be repeated at a minimum of 3 years, or more often if BMI is increasing. Accordingly, testing for prediabetes and/or type 2 diabetes should be considered in women planning a pregnancy who are overweight or obese and/or have one or more additional diabetes risk factors.

Routine tests for prediabetes are as follows:
Fasting Hemoglobin Glucose and HbA1c Bilan lipids: total cholesterol, LDL-C, HDL-C, triglycerides Uric acid, creatinine SGOT and SGPT Urine test find albuminuria Electrocardiogram full 12 leads

Treatment of pre-diabetes aims to return blood glucose to normal; prevent or slow the progression to diabetes; prevent and reduce complications caused by hyperglycemia.
In addition, the aim is to reduce the risk of cardiovascular disease through detection and treatment of associated cardiovascular risk factors.

Target HbA1c < 5.7% Lose at least 3-7% weight in overweight/obese and stay there Waist < 80 cm for women, < 90 cm for men Achieving activity at least 30 minutes/day of moderate-intensity exercise, at least 5 days per week. Good control of cardiovascular risk factors (if any) including hypertension, dyslipidemia, and smoking cessation.

Nutritional moderation
Applying a reduced-energy, fat-reducing diet with gradual weight loss for overweight and obese people. Choose foods with low glycemic index, whole grains, rich in fiber, vegetables, fruits, not processed industrially, unsaturated fats (vegetable oils, fish). For people who are not overweight or obese: no need to lose weight, just change the food choices above. Regular physical activity
Needs to burn about 700 calories/week, which is equivalent to 150 minutes/week of moderate-intensity exercise like brisk walking. Minimum 30 minutes a day, at least 5 days a week. No less than 10 minutes each time. Reduce sedentary time.

In the treatment of prediabetes, Metformin is the first choice. After 3 months of using diet and exercise, HbA1c could not be controlled < 5.7%. Subsequent follow-ups recorded a gradual increase in blood glucose. Indicated to use Metformin right from the time of detecting pre-diabetes if accompanied by 1 of the following criteria:
BMI ≥ 25kg/m2 < 60 years Women with a history of gestational diabetes Having both fasting blood glucose and tolerance disorders Glucose intake Other risks: 1 of these factors (HbA1c >6%, hypertension, low HDL (<0.9 mmol/L), high triglycerides (>2.52 mmol/L), family history First, diabetes) Drug dose: starting at 500mg/24 hours, gradually increasing the dose, up to a maximum of 2000mg/24 hours. Other drugs that may be considered as an alternative if the patient is intolerant to Metformin: alpha-glucosidase inhibitors, GLP-1 receptor agonists, TZDs.

Bariatric surgery, weight loss to help control blood glucose. Indicated for severe obesity (BMI > 35kg/m2) It is necessary to combine medical treatment closely after surgery

High blood pressure Dyslipidemia Smoking increases the risk of type 2 diabetes and cardiovascular events

Frequency of check-ups once a month, fasting blood glucose test (HbA1c is done every 3 months)
Women diagnosed with gestational diabetes need long-term monitoring, testing at least every 3 years
Patient Prediabetes patients should be screened every year If results are normal, testing should be repeated in 1-3 years or less depending on initial results and risk factors.

Pre-diabetes screening questionnaire

If your total score is ≥ 5 points, it means you are at high risk for type 2 diabetes. In this case, you should see your doctor to check your blood sugar to screen for pre-diabetes and diabetes.
People with pre-diabetes are often less able to detect the disease based on the signs and symptoms of the disease. Therefore, it is necessary to regularly monitor and undergo periodic health check-ups to detect the disease early for timely treatment to avoid the risk of progression to diabetes and the risk of serious complications.
Currently, Vinmec International General Hospital has been and continues to deploy a screening package for diabetes and dyslipidemia to help detect pre-diabetes early, accurately classify diabetes type, and at the same time develop a nutritional regimen, monitor and minimize the risks and complications caused by diabetes. At Vinmec, it is not only outstanding by its comprehensive and professional medical examination, consulting and treatment services; civilized, polite, safe and sterile medical examination and treatment space. There is also a team of leading and highly specialized medical doctors, so customers can completely trust the methodical examination and treatment process at Vinmec.

References
Standard of Medical Care in Diabetes ADA 2020 Guidelines for the diagnosis and treatment of pre-diabetes, Ministry of Health 2020 Guidelines for diagnosis and treatment of type 2 diabetes, Ministry of Health 2017