Prediabetes Awadhesh Med

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Prediabetes Awadhesh Med

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  • 1. Dr. Awadhesh Sharma Study of Microvascular & Macrovascular Complicationsin Prediabetics (Impaired Glucose Tolerance) Department of Medicine MLB Medical College, Jhansi

2. What is pre-diabetes? Pre-diabetes is a condition where blood sugar levels are higher than normal, but not yet high enough to be diagnosed as diabetes. Pre-diabetes is a key factor in the development of type 2 diabetes.However, n oteveryone with pre-diabetes goes on to develop type 2 diabetes. Pre-diabetes is characterized by disturbance in blood sugar levels as measured by impaired glucose tolerance (IGT) or impaired fasting glucose (IFG). Patients can have one or both of these conditions to be considered pre-diabetic. 3. 4.

  • Global Burden
  • Worldwide, 230 million people have diabetes and in 2003, more than 300 million people were estimated to have pre-diabetes. By 2025, it is estimated that approximately 500 million people will have pre-diabetes.
  • Southeast Asia currently has the highest number of people with pre-diabetes. By 2025, it is estimated that Southeast Asia will continue to have the highest prevalence of pre-diabetes (13.5 percent), followed by Europe (10.9 percent).

5. Diagnosis Criteria

  • One test is not enough!
  • The diagnosis must be done by a physician.

*FBG blood test is done after fasting 8 hours. ** GTT results are repeated after 2 hours. A person drinks a 75 mg glucose solution before test. 100 mg for Pregnant women. Normal Pre diabetes Diabetes Fasting Blood Glucose Test (FBG)* Less than 100 Between100 - 125 More than or equal to126 Glucose Tolerance Test (GTT) ** Less than 140 Equal to or more than140but less than200 More than or equal to200 6. Why We Worry About Prediabetes?

  • Predicts high risk for development of diabetes
  • Predicts high risk for development of atherosclerotic vascular disease
  • Both are largely preventable through lifestyle and pharmacologic interventions

7. Risk of Cardiovascular Disease Is Elevated Prior to Diagnosis of T2DM % with CVD *MI=myocardial infarction. Adapted from: Hu F, et al.Diabetes Care.2002;25:1129-1134. 8.

  • Does everyone with pre-diabetes develop type 2 diabetes?
  • Although people with pre-diabetes are at an increased risk for developing type 2 diabetes, not everyone goes on to develop the disease.
  • Large clinical outcomes trials have demonstrated that:
  • Between 29 percent and 55 percent of people with pre-diabetes develop type 2 diabetes over the course of three years.
  • In other trials of longer duration, these rates increased to between 43 percent and 68 percent over six years.

9. Symptoms of Prediabetes

  • Symptoms of diabetes appear when the levels of glucose are either very high or very low.
  • Many persons with diabetes and all those with pre-diabetes do not have symptoms.
  • The most common symptoms are:
    • Fatigue, tiredness or lack of energy
    • Excessive constant thirst or hunger
    • Frequent need to urinate
    • Skin wounds that do not heal or heal very slowly
    • Blurred vision

10. Risk Factors for the Development of S Prediabetes

  • Family history of diabetes
  • Class of obesity
    • Especially central
  • Hypertension
  • High triglycerides
  • Low HDL-C
  • Elevated glucose
  • Ethnicity other than Caucasian
  • Vascular disease
  • History of gestational diabetes
  • History of baby weighing > 9 lbs
  • Sedentary lifestyle


      • Overweight and obesity
      • Sedentary lifestyle
      • An increase of lipids (fats) in the blood
      • High blood pressure


          • Increasing age
          • Family History: Inheritance
          • Background of Gestational diabetes
          • Race/Ethnic group

13. Body Mass Index (BMI)

  • 18.5 - 24.9 = NORMAL
  • 25- 29.9 = OVERWEIGHT
  • Persons with BMI >25 have risk of Diabetes
  • BMI combines height and weight measurements
  • Read the result in a BMI chart.


  • The normal values are:
  • WOMEN= 34or95 CM
  • MEN = 37 or100 CM

Waist Circumference (WC) It is a simple measurement at waist level 15. Sedentary Lifestyles

  • Lack of exercise
  • The comforts of modern living

16. Increase of Lipids (Fats) in the Blood

      • A person is at risk of developing diabetes if,
      • The levels ofHDLare low
      • The levels ofLDLare high
      • The levels ofTRIGLYCERIDESare high

Lipids Normal Values Total Cholesterol Less than200mg/dl

  • LDL cholesterol

Less than100mg/dl

  • HDL cholesterol

Men:Higher than45mg/dlWomen: Higher than55mg/dlTriglycerides Less than150mg/dl 17. High Blood Pressure

  • A person is at risk of developing diabetes if blood pressure is140/90mm Hg or more.
  • Aperson with diabeteshas more risk of complications if blood pressure is130/80mm Hg or more.

18. Our Study 19.

  • Aims and objectives
  • To study microvascular and macrovascular complications in prediabetes

20. Material & Methods The study entitled Study of Microvascular & Macrovascular Complications in Prediabetics (Impaired Glucose Tolerance) was conducted in the department of Medicine of M.L.B. Medical College, Jhansi from the period of June 2006 to September 2009. The cases were patients coming to Medicine OPD and in the emergency being admitted in the Medicine ward as cases of impaired glucose tolerance or prediabetes. Fifty patients of prediabetes were included in the study which are selected from Medicine OPD and those who admitted in the Medicine ward. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34.

  • Results
  • The following conclusionscan be drawn from the present study :-
    • Annual progression to diabetes inprediabetics was 5% per year.
    • Majority of them (prediabetics) suffered from cardiovascular complications i.e. 20%.
    • Incidence of cerebrovascular complications is 6%.
    • Incidence of peripheral vascular disease is 8%.
    • Incidence of retinopathy is 8%.
    • Incidence of nephropathy in the form of microalbuminuria is 4%.
    • Incidence of complications is more in subjects having multiple risk factors.

35. How we manage ? 36. Health Physical Activity + Sound Nutrition Good Health 37. Health The first part of our equation is activity Get moving, find something you enjoy 38. Health The second part of the equation is nutrition Your body needs the right fuel to help it work well. 39. How Can You Help Reduce Your Risk of Diabetes? Eat foods low infat & calories. If overweight, lose weight. Physical activity Stop smoking! Limit alcohol to 1-2 drinks per day. Take yourmedications regularly. 40. Encourage people to change habits . Use the pyramid guide to educate people to eat healthy. 41. Is drug therapy useful in patients with pre-diabetes? Drug therapy is not recommended by the ADA due to the limited efficacy of treatment versus lifestyle modification, potential for adverse drug reactions, lack of data supporting reduction of microvascular or macrovascular complications of diabetes in this patient population, and insufficient assessment of the cost-effectiveness of drug treatment. However, not all patients are able to implement lifestyle modifications due to physical or otherlimitations, and based on limited data available, drug therapy may be a reasonable option to delay onset of type 2 diabetes and provide a cardiovascular benefit (TRIPOD and STOP-NIDDM data). 42. THANK YOU