A national laboratory tested over 290,000 persons over 5 years in Mumbai and found that every third person had prediabetes. International Diabetes Federation reported that Indians with diabetes to be 74 million while those with prediabetes to be 40 million. Eminent Endocrinologist Dr Shashank Joshi, Chair of IDF-South East Asia in 2021, stated that India has two burdens namely prediabetes and asymptomatic diabetes (1). National Urban Survey showed 14% Indians had prediabetes. Eminent nephrologist Dr Chandan Choudhary estimated that about 12.3% of Indians had prediabetes, of which about 8.4% were adolescents and adults (2).
What is Prediabetes?
In prediabetes condition, one has higher blood sugar levels than is considered normal but not high enough to be diabetic. If not managed, it can lead to Type 2 diabetes. People having prediabetes have 50% chance over the next 5 to 10 years of developing diabetes. However, one can take steps to avoid it. Prediabetes does not always show symptoms so it is only the blood sugar level testing that would show if a person has prediabetes. Early detection gives better chance to prevent development of diabetes (3).
How is Prediabetes Diagnosed? (4)
Blood sugar will have to be tested to find out if one has prediabetes or any other type like type 1, type 2 or gestational diabetes. There are a couple of tests need to be done in order to diagnose it.
|Result*||A1C Test||Fasting Blood Sugar Test||Glucose Tolerance Test|
|Diabetes||6.5% or above||126 mg/dL or above||200 mg/dL or above|
|Prediabetes||5.7 – 6.4%||100 – 125 mg/dL||140 – 199 mg/dL|
|Normal||Below 5.7%||99 mg/dL or below||140 mg/dL or below|
Fasting blood sugar test is measured after overnight fasting without eating. It the blood sugar is 99 mg/dL or lower then, it is normal, but if it is between 100 & 125 mg/dL, it means prediabetes and if it is 126 mg/dL or higher then one has diabetes.
Glucose tolerance test is done to confirm the above. Blood sugar is measured after drinking a liquid containing glucose or sometimes it is done after eating a good breakfast containing carbs. If the sugar is 140 mg/dL or lower than the person is normal, but if it is between 140 & 199 mg/dL the person has prediabetes and 200 mg/dL or higher indicates diabetes.
There is one more test hemoglobin A1C or HbA1C test that measures average blood sugar levels over a period and is helpful in managing the disease. When sugar in the blood attaches to hemoglobin which happens in everyone. People with higher blood sugar will show higher level of sugar-attached hemoglobin. Value of A1C below 5.7% is normal, but 5.7 to 6.4% shows prediabetes and 6.5% or higher shows diabetes.
Risk Factors for Prediabetes (5, 6)
Prediabetes does not get as much attention as diabetes as the latter can lead to serious health problems including heart attack, kidney failure, amputation, blindness and others. However, prediabetes not only affects three times as many people and if untreated may lead to diabetes. It gives a window of opportunity to prevent diabetes. As there are very few clues or symptoms so one must actively try to find out if one has prediabetes after looking at the risk factors.
The factors that increase the risk of diabetes such as overweight or obesity, inactivity and family history among others also increase the chances of prediabetes. Age over 45 years has increased chance, although many children and adolescents are diagnosed with prediabetes. Diet, stress and ethnicity also play a role. Africans, Hispanic and Asians have shown a tendency to become prediabetic. Large percentage of Indians are been shown in many surveys and studies to be prediabetic.
People who are in the high risk should pay attention to any persistent fatigue or after a large meal if there is any experience of repeated urination or blurry vision. These signs show a temporary surge of blood sugar levels. Actual confirmation can be with diagnostic tests. Early detection will help manage the problem.
Prevention and Care
Physical activity and losing weight are the best steps a person can take to prevent prediabetes and onset of diabetes. A person who was inactive and has a weight problem may take a while starting with shorter goals. Diet control will help achieve the above. All this should be done with qualified health professional.
A recent ICMR-India Diabetes study (7) across urban and rural areas of 31 states in India has shown that non-communicable disease rates are rising rapidly in India. Among other findings, it was noted that prediabetes is affecting over 15% of over one lakh individuals examines. These are the preliminary signs of bigger problems following in near future. So there is an urgent need to improve the health of Indians especially by improving physical activity and weight management with the help of proper diet and the checkup of blood sugar for those with high risk factors.