Pre-diabetes: Risk Factors & Diagnosis Saoirse Ní Chuirrín DNS Caitriona Lordan Dietitian...

Pre-diabetes: Risk Factors & Diagnosis

Saoirse Ní Chuirrín DNS

Caitriona Lordan Dietitian

September 2015

Saoirse Ní Chuirrín Bon Secours Hospital

What is pre-diabetes?

This is a condition in which blood glucose levels are higher than normal but not high enough to be diagnosed as Type 2 Diabetes.

Pre-diabetes is the new term used for individuals with impaired fasting glucose (IFG) or impaired glucose tolerance (IGT). Previously ‘borderline diabetes’.


So what’s the difference?

2 different pathophysiological mechanisms!

IFG – high after a period of fasting

IGT – high post prandial


Diagnosis

ADA Guidelines Fasting plasma glucose 5.6 – 6.9mmol/l (IFG)

or 2 hour result in the 75g OGTT 7.8- 11.0mmols

(IGT)

or HbA1c 39 - 46mmol/mol (5.7 -6.4%)


Diagnosis

WHO Fasting plasma glucose 6.1 – 6.9mmols/l

and 2 hour result in the 75g OGTT 7.8- 11.0mmols

(IGT)

HbA1c alone not recommended for diagnosis


Diagnosis - Our approach!

Fasting plasma glucose 6.1 – 6.9mmols/l WITH 2 hour result in the 75g OGTT 7.8- 11.0mmols (IGT) OR HbA1c –guide 39 - 46mmol/mol (5.7 -6.4%)

*FPG alone could mean diabetes may go undiagnosed!


Prevalence

Ireland VHI Health screening project 2009 – 2013.

30,000 Participants

11.8%- abnormal glucose levels

IDF 2014 – estimate 70,600 undiagnosed cases of diabetes in Ireland.


Significance?

Indicates an increased future risk of developing Type 2 Diabetes

Increased risk of CVD Increased risk of microvascular complications Associated with obesity


Who to screen?

All adults who are overweight (BMI >25) High risk race – e.g.African American,Asian,

Latino. Physically inactive Family history of diabetes Hypertension/CVD High triglycerides or high total cholesterol


Who to screen?

Women who have delivered a baby >9lbs or who have had gestational diabetes

Women with polycystic ovary syndrome Previous abnormal result


Treatments

Priority- Reduce insulin resistance! ↑ physical activity Improving dietary choices Weight management & weight loss programmes ?Metformin – delay conversion to diabetes Mange risk factors – smoking, cholesterol, BP


US- Diabetes Prevention Programme(DPP) 3234 participants – Pre-diabetes/overweight

1)Lifestyle intervention group – intensive training on diet/exercise/behaviour modification

2)Metformin group – also info on diet/exercise

3)Placebo – info diet/exercise


DPP

1) Lifestyle- ↓the risk by 58%Diabetes developed in 14%

2) Metformin - ↓the risk by 31%. Diabetes developed in 22%

3) Placebo pills – diabetes developed in 29%

Weight loss & physical activity works!


Caitriona Lordan- Dietician

Caitriona Lordan Bon Secours Hospital

Behavioural Strategies

Shop with a list and stick to it

Don’t shop when hungry

Take someone supportive with you

Shop the perimeter of the store



Do not be tempted by “bargains”

Freeze extra food

Use opaque containers in the fridge

Avoid preparing too much food

Avoid tasting food when preparing



Eat in one room at a table

Use smaller plates

Put knife and fork down between mouthfuls

Half the plate should be vegetables or salad

Don’t use food as a reward


Unhelpful Thinking Styles

Black and white thinking

Catastrophising

Minimising the good things


Enjoy your food


Thank you!

Pre-diabetes: Risk Factors & Diagnosis Saoirse Ní Chuirrín DNS Caitriona Lordan Dietitian...

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