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Prediabetes
This document discusses pre-diabetes, including its definition, prevalence, health risks, diagnostic criteria, and treatment options. Some key points: - Pre-diabetes is when blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes. Left untreated, pre-diabetes often progresses to type 2 diabetes. - Studies like the Diabetes Prevention Program showed that modest lifestyle changes like 5-10% weight loss and moderate physical activity can prevent or delay the onset of diabetes in those with pre-diabetes. - In addition to lifestyle changes, pharmacologic treatments like metformin may be considered for high-risk individuals to prevent the progression from pre-diabetes to diabetes. However,
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Prediabetes
- 1. Pre-diabetes Dr B KMISHRA
- 2. What is prediabetes? • Blood glucose levels are higher than normal but not high enough to be type 2 diabetes • More likely to develop type 2 diabetes • May have some diabetes related problems
- 3. Btps hospital data2012 • Out of hundred employees (annual medical check) • Diabetes-27 • Prediabetes-10 • Hypertension-30 • Hyperlipidemia-13 • IHD-3 • Asthmatic bronchitis-3 • Medically fit-14
- 4. How to knowprediabetics? • FPG-normal- less than 100mg/dl • prediabetes 100 to 125mg/dl • diabetes more than 126mg/dl • OGTT-over night fast followed by 75gm glucose 2hr PPBS-lessthan 140mg normal • prediabetes140 to 199mg • diabetes more than 200mg/dl • Hba1c-less than5.6 normal 5.7 to 6.4 prediabetes morethan6.5 diabetes.
- 5. ADA Diagnostic Criteria: Normal,Diabetes, and Pre-diabetes Clinical Practice Recommendations 2010 In the absence of unequivocal hyperglycemia, criteria 1, 2, and 4 should be confirmed by repeat testing. Parameter Normal Diabetes Pre-diabetes Method 1 Fasting Plasma Glucose (mg/dl) <100 ≥126 100–125 No caloric intake for at least 8 h 2 2-h plasma glucose on OGTT (mg/dl) <140 ≥200 140–199 WHO method: 75 g glucose load 3 Random plasma glucose (mg/dl) <140 ≥200 - with classic symptoms of hyperglycemia or crisis 4 A1C % <5.7 ≥6.5 5.7 – 6.4 NGSP certified method standardized to the DCCT assay
- 6. The Epidemic of Diabetesand Pre-diabetes • Diabetes: 30 million and increasing. • Pre-diabetes: 57 million: About 1/4 (22.6%) of overweight adults aged 45–74 (CDC data) “What lies beneath…” http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2007.pdf http://www.cdc.gov/diabetes/pubs/factsheets/prediabetes.htm
- 7. Pre-Diabetes in the Youngand the Old • The diabetogenic process begins early – low birth weight and poor nutrition • Diabetes epidemic due to: -lack of exercise and overweight in young persons, and -aging of the population • Correlation with central obesity, insulin resistance, glucose intolerance, high blood pressure , and dyslipidemia – metabolic syndrome
- 8. The Metabolic Syndrome: NCEPATP III Criteria (May 2001 Guidelines) 3 of the Following Risk Factor Defining Level Abdominal Obesity (waist circumference) Men >40 inches (102 cm) Women >35 inches (88 cm) Triglycerides 150 mg/dL HDL Cholesterol Men <40 mg/dL Women <50 mg/dL Blood Pressure 130/85 mmHg Fasting Glucose 110 mg/dL NCEP ATP III. JAMA. 2001;285:2486-2497.
- 9. What are thehealth risks associated with pre-diabetes? • Progression to diabetes: on average, 11% of people with pre-diabetes develop type 2 diabetes each year (DPP) • Other studies: majority with pre-diabetes develop type 2 diabetes in 10 years • Presence of microvascular complications at onset of diabetes • 50% higher risk of CVD: CAD and stroke
- 10. CDC Data http://www.cdc.gov/diabetes/pubs/factsheets/prediabetes.htm accessed June2010 Among adults with pre-diabetes in 2000, the prevalence of cardiovascular (heart) disease risk factors was high: 94.9% had dyslipidemia (high blood cholesterol); 56.5% had hypertension (high blood pressure); 13.9% had microalbuminuria 16.6% were current smokers
- 11. Who should gettested for pre- diabetes? • Age 45 or older • Overweight • Family history of diabetes • Other risk factors for diabetes or pre-diabetes: sedentary lifestyle, hypertension, low HDL cholesterol, high triglycerides, history of gestational diabetes or giving birth to a baby weighing more than 4 KG, or belonging to an ethnic or minority group at high risk for diabetes
- 12. Acanthosis Nigricans: a Signof Insulin Resistance • Velvety, light- brown-to-black discoloration usually on the neck, axilla, groin, dorsum of hands • May point to PCOS in females • Insulin sensitivity decreases by 30% at puberty with compensatory increase in insulin secretion
- 13. How often shouldbe testing done? • Every 3 years if glucose tolerance is normal • Every 1-2 years if pre-diabetes is diagnosed
- 14. What is theTreatment for Pre-diabetes? • Pre-diabetes is a serious medical condition! • It CAN be treated • TRIALS: Da Qing 1997, Finnish study 2001, DPP 2002: persons with pre-diabetes can prevent the development of T2DM by sustained lifestyle changes • 5-10% reduction in body weight coupled with 30 minutes a day of moderate physical activity • Reversal of pre-diabetes and return of blood glucose levels to the normal range is possible
- 15. DPP: Intensive LifestyleChanges Reduce the Risk of Developing Type 2 Diabetes • 27 centers nationwide (1998-2002) • Pre-diabetes, av. age 51, BMI 34, 68% women, 45% minority participants • Other groups at high risk: >60, women with h/o GDM, first- degree relative with diabetes • > 7% loss of body weight and maintenance of weight loss • Dietary fat goal -- <25% of calories from fat • Calorie intake goal -- 1200-1800 kcal/day • > 150 minutes per week of physical activity Parameter Placebo Metformin 850 mg bid Lifestyle: diet, exercise, behavior modification Weight Loss none 5 lbs 1st yr: 15 lbs, end 10 lbs Diabetes at 2.8 yrs 11% 7.8% 4.8%
- 16. ADA Consensus Statement: Preventivetreatment in high-risk individuals with pre-diabetes Diabetes Care 2007 In addition to lifestyle modification, the following individuals should be considered for treatment with metformin: -those who have both IFG and IGT, and -at least one additional risk factor (age <60, BMI ≥35, FH of diabetes in first degree relative, elevated TGs, reduced HDL, or A1C >6%
- 17. How to preventprediabetic to become diabetic • Weight management • Correct eating habits • Regular exercise • Specialised supplements
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- 21. How to calculatetotal body fat?
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- 37. Eat plenty offruits and vegetables
- 40. The root causeof all menance
- 53. Kum khao sahikhao aur pachao
- 54. Bring balance toyour life by YOGA AND MEDITATION
- 55. Preventive Strategies andEvidence- based Interventions that make sense • Changes at the individual level • Community- and population-based
- 56. Pharmacologic Treatments forPre-diabetes • Since many individuals with pre-diabetes are generally healthy, benefits of preventive therapy must outweigh any associated side-effects or risks • Expense • None are FDA-approved Agent Study RRR Side-effects Metformin Glucophage Da Qing, Finnish, DPP 28% GI Acarbose Precose STOP-NIDDM 25% GI, poor compliance Rosiglitazone Avandia DREAM 62% Bone loss, edema, CHF Orlistat Xenical, Alli XENDOS 52-62% GI, poor compliance