Prediabetes/Early diabetes: A Second Chance to Prevent Diabetes?

Diabetes is a global health burden that affects hundreds of millions1 with Malaysia having one of the highest prevalence of diabetics2. Whilst diabetes is widely diagnosed, there is a lesser known condition called prediabetes/early diabetes, which precedes diabetes.

Prediabetes/early diabetes is defined as a state whereby glucose levels do not meet the criteria for diabetes but are too high to be considered normal3. Prediabetes/early diabetes could manifest as impaired fasting glucose (IFG), impaired glucose tolerance (IGT) or both4, up to 13 years prior to the diagnosis of diabetes5.

Impaired fasting glucose (IFG):

  • Hepatic insulin resistance and normal muscle insulin sensitivity6
  • Chronic elevation of fasting plasma glucose occurs in the absence of a deterioration in postprandial glucose control4

Impaired glucose tolerance (IGT):

  • Normal to slightly reduced hepatic insulin sensitivity and moderate to severe muscle insulin resistance6
  • Postprandial glucose control is impaired but fasting glucose is normal4

In Malaysia, every 1 in 6 adults is diagnosed with IGT while the number of adult IGT patients is expected to increase from 3.3 million in 2017 to 5.0 million in 20451. Approximately 70% of prediabetics /early diabetics would eventually develop diabetes6, with 11% progressing to type 2 diabetes within a year7.  Aside from type 2 diabetes, prediabetics/early diabetics have a higher risk of developing several complications such as cardiovascular disease, stroke, neuropathy (nerve damage), nephropathy (kidney disease) and retinopathy (progressive loss of vision)8.

As there are no obvious signs and symptoms, it is unsurprising that 9 out of 10 people with prediabetes/early diabetes are completely unaware of their condition9. Hence, FPG, OGTT and Hba1c tests are recommended for patients aged about 35 years and/or high risk individuals that include2:

  • Overweight or obese individuals
  • Family history of diabetes
  • History of gestational diabetes
  • High blood pressure
  • Dyslipidemia

Long-term clinical studies have revealed that intensive lifestyle modification or pharmacological treatments such as metformin and acarbose at the prediabetes/early diabetes stage can delay or even prevent progression to diabetes7,10,11. Whilst there are emerging evidence suggesting that supplements such as bitter gourd could reduce FPG in prediabetics/early diabetics12, the National Pharmaceutical Regulatory Agency (NPRA) has only approved metformin for prediabetes/early diabetes treatment following 3 to 6 months of ineffective lifestyle modification13.

Awareness of prediabetes/early diabetes is critical to act as a wake-up call for many to make the necessary changes to delay or reverse the progression of diabetes.

References:

  1. IDF Atlas 8th Edition, 2017.
  2. Mirasol et al. JAFES. 2017. 32; 1: 1-7.
  3. American Diabetes Association. Diabetes Care 2018. 41(Supp. 1): S13-S27.
  4. Hostalek et al. Drugs. 2015. 75(10), 1071–1094.
  5. Tabak et al. Lancet. 2009. 373: 2215-2221.
  6. Nathan et al. Diabetes Care 2007. 30(3): 753-759.
  7. Knowler et al. N Engl J Med. 2002. 346(6):393-403.
  8. Brannick et al. Exp Biol Med (Maywood). 2016. 241(12): 1323-31.
  9. Prediabetes: Your Chance To Prevent Type 2 Diabetes. https://www.cdc.gov/diabetes/basics/prediabetes.html
  10. DPP Research Group. Lancet Diabetes Endocrinol. 2015. 3: 866-75.
  11. Holmann et al. Lancet Diabetes Endocrinol. 2017. 5(11):877-886.
  12. Krawinkel et al. J Ethnopharmacol. 2018. 216:1-7.
  13. National Pharmaceutical Regulatory Agency. DCA 332.

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