"I don't have symptoms of thirst, polydipsia, polyuria, how come my blood sugar is overshoot?"
Looking at the physical examination list with "obesity, fatty liver (moderate), pre-diabetes" and other diagnoses, 35-year-old Xiao Zhang, a face of confusion and anxiety.
Prediabetes is the transition stage from normal blood sugar to diabetes, and can also be understood as one foot has stepped into the door of diabetes.
In China, the number of prediabetes is estimated to be 148 million, or nearly 150 million [1]. Their blood sugar is secretly rising, just one step away from real diabetes.
Many people may be as confused as Xiao Zhang: to what extent is the blood sugar high and considered prediabetes? How to avoid developing diabetes? Do you want to take hypoglycemic drugs? Is there a chance of reversal?
Today, we will help you recognize the latent "killer" of pre-diabetes.
Scientists have long been concerned that there is a slight increase in blood sugar in some people, and initially used the terms impaired fasting blood glucose (IFG) or impaired glucose tolerance (IGT) to define this part of the high-risk group that may develop diabetes in the future.
But these two awkward medical professional terms are difficult for ordinary people and doctors to pay enough attention.
To this end, in 2001, the American Diabetes Association (ADA) replaced "impaired fasting blood glucose" and "impaired glucose tolerance" with a more understandable term, prediabetes, and quickly spread to the world through the ADA Diabetes Guidelines [2].
So, how do doctors diagnose prediabetes?
The fasting blood glucose < of normal people is 6.1 mmol/L, and the blood glucose < 7.8 mmol/L 2 hours after oral glucose tolerance;
The fasting blood glucose ≥ of diabetics is 7.0 mmol/L, and the blood glucose ≥ 11.1 mmol/L 2 hours after oral glucose tolerance;
Prediabetes is somewhere in between, with fasting blood glucose ranging from 6.1 to 6.9 mmol/L and/or 2 hours after oral glucose tolerance ranging from 7.8 to 11.0 mmol/L [1].
If any of these metrics are met, you've joined the "reserve army" for diabetes.
According to the Expert Consensus on Prediabete Intervention in Adults in China[1] released in 2020, the prevalence of prediabetes in mainland China is 15.5%, and it is estimated that there are 148 million people, which is a larger number than the number of diabetic patients.
Of course, in reality, it is impossible to directly screen everyone for diabetes, and doctors generally assess diabetes risk through the Chinese diabetes risk score scale first. This table is suitable for people aged 20 to 74 years, with a score range of 0 to 51 points, and those with a total score of ≥ 25 are at high risk and need to be screened for oral glucose tolerance test (OGTT).
If you are interested, you can give yourself a score to see if you are a high-risk group.
(China Diabetes Risk Score Table[1])
Although prediabetes is not yet diabetic and there are no obvious symptoms of "three more and one less", if left unintermediated, about 5 to 10 percent of prediabetes people develop diabetes each year [1,3]. Moreover, prediabetes is also associated with an increased risk of cardiovascular disease, microvascular disease, tumors, dementia, depression and other diseases.
So, before diabetes develops, we have to look for opportunities to stop it in time.
Many people are very nervous when they hear "prediabetes". But in fact, as long as the active living habit intervention is carried out in time, the disease at this stage may be delayed.
How to intervene in prediabetes? Do you want to take hypoglycemic drugs?
The "Expert Consensus on Prediabete Intervention in Adults in China" recommends that you should not rush to take medicine first, and it is important to control your weight first.
That is, through diet control and exercise, let your body mass index (BMI) reach or close to 24kg/m2, or lose at least 5% of your body weight within 3 to 6 months, and maintain it for a long time. (Note: BMI = weight (kg) ÷ height (m) square)
Interventions that persist in lifestyle over a long period of time can reduce the risk of diabetes by 39 to 58 percent [4].
Image source: Stand Cool Helo
Why does prediabetes put more emphasis on weight control? This is because obese and overweight people, due to too much body fat, cells are less sensitive to glucose, the demand for insulin is more vigorous, islet β cells are overloaded for a long time, and they are more likely to become diabetic.
For overweight or obese people, the total daily dietary calories are reduced by at least 400 to 500 kcal (1 kcal = 4.184 kJ), and the intake of saturated fatty acids is controlled to account for less than 30% of total fatty acid intake [1].
In terms of sports, priority is given to running, swimming, cycling, aerobics, tai chi, table tennis, badminton and other moderate intensity (a little laborious during exercise, rapid heartbeat and breathing but not rapid) aerobic exercise, not less than 30 minutes a day [1].
If you don't want to be found by "diabetes", you have to keep a snack on the physical examination.
Everyone should develop the habit of regular physical examination and blood glucose measurement, and achieve early detection and early intervention in the pre-diabetic period, so as to nip the risk of diabetes in the bud.
Healthy China Action (2019-2030) recommendations[5]:
People 40 years of age and older, fasting blood glucose is tested at least once a year;
In prediabetes, fasting blood glucose is detected every 6 months or 2 hours after a meal.
Any of the following characteristics satisfy any of the high-risk groups for diabetes, and it is recommended to check blood glucose once a year [4]:
(1) Have a history of prediabetes;
(2) Age ≥ 40 years;
(3) Body mass index (BMI) ≥ 24 kg/m2 and/or central obesity (male waist circumference ≥ 90 cm, female waist circumference ≥ 85 cm);
(4) First-degree relatives have a history of diabetes;
(5) Lack of physical activity;
(6) Women with a history of large childbirth or a history of gestational diabetes;
(7) Women with a history of polycystic ovary syndrome;
(8) Those with acanthosis nigricans;
(9) Those who have a history of hypertension or are receiving antihypertensive therapy;
(10) HDL cholesterol 2.22mmol/L, or those who are receiving lipid-modulating drugs;
(11) Have a history of atherosclerotic cardiovascular disease;
(12) Have a history of steroid use;
(13) Long-term treatment with antipsychotic drugs or antidepressants;
(14) The total score of China's diabetes risk score table ≥ 25 points.
In general, prediabetes are like standing at a crossroads, your blood sugar, your body's future, are in their own hands.
However, please believe that as long as appropriate and regular life intervention is adopted, it may be reversed to a normal blood glucose population and avoid the occurrence of diabetes.
Reviewers:
Guo Qiyu |Chinese chief physician of the Department of Endocrinology, Sixth Medical Center, General Hospital of the People's Liberation Army
Luo Yingying | deputy chief physician of the Department of Endocrinology, Peking University People's Hospital
bibliography:
[1] Endocrinology Branch of Chinese Medical Association, Diabetes Branch of Chinese Medical Association, Endocrinology and Metabolism Physician Branch of Chinese Medical Doctor Association, et al. Expert consensus on prediabete intervention in adults in China[J]. Chinese Journal of Endocrinology and Metabolism, 2020, 36(5): 371-380
[2] Advances in medicine or the welfare of pharmaceutical companies? The Journal of Science bombards the concept of prediabetes as it is and isn't. Physician's report https://mp.weixin.qq.com/s/wzL0ezoM8-_SO0XkCYj0Yw
[3] Knowler WC, Fowler SE, Hamman RF, et al. 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study[J]. Lancet, 2009, 374(9702):1677-1686. DOI: 10.1016/S0140-6736(09) 61457-4.
[4] China's Guidelines for the Prevention and Treatment of Type 2 Diabetes (2020 Edition) Chapters 1-4. Chinese Journal of Diabetes.https://mp.weixin.qq.com/s/_P6kfSxa05IPEIKSyi34kw
[5] Healthy China Action (2019-2030) http://www.gov.cn/xinwen/2019-07/15/content_5409694.htm
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