Q. I recently read a short news article about a disease called pre-diabetes, but the article did not discuss the condition well-enough. What is pre-diabetes? How does it differ from diabetes? 

—Lony R., Pasay City

A. Pre-diabetes is a newly-coined medical term that was introduced in 2002 by the American Diabetes Association. Actually, it is merely a re-labeling of the condition that was previously called Impaired Glucose Tolerance (IGT) or Impaired Fasting Glucose (IFG). It refers to blood glucose levels that are higher than normal but still lower than those required for a diagnosis of diabetes mellitus.

As a rule, people with pre-diabetes have no symptoms. Their condition is diagnosed when they undergo either or both of two equally reliable laboratory examinations that utilize blood as sample: Fasting blood sugar (FBS) and oral glucose tolerance test (OGTT).

The normal FBS (i.e., blood sugar or glucose level after an overnight fast) is below 100 mg per deciliter (mg/dl). In contrast, the FBS of someone with diabetes is 126 mg/dl or higher. Thus, someone who has an FBS that is 100-125 mg/dl has pre-diabetes.

On the other hand, in the glucose tolerance test (OGTT) where blood glucose level is determined two hours after drinking a sugar-rich beverage (i.e., one with 75 grams of glucose), the normal blood sugar or glucose level is below 140 mg/dl. A person with a 2-hour blood glucose level of 200 mg/dl or over has diabetes, while a person with a value that is 140-199 mg/dl has pre-diabetes.

Pre-diabetes is a clinically important condition because many people with pre-diabetes subsequently develop type 2 diabetes (the type of diabetes that accounts for 90 to 95 percent of all cases of diabetes mellitus). Also, type 2 diabetes is almost always preceded by pre-diabetes.

Aside from serving as a herald for diabetes, pre-diabetes carries some other health risks. Studies indicate that people with pre-diabetes have a 1.5-fold risk of cardiovascular disease compared to people with normal blood glucose. Furthermore, studies also suggest that the damage that diabetes mellitus causes to the various vital organs of the body—heart, blood vessels, eyes, kidneys, etc.—actually starts during pre-diabetes.

Pre-diabetes is therefore a dangerous condition that has to be treated. Treating pre-diabetes can prevent, or at least delay, the occurrence of type 2 diabetes. A study among people with pre-diabetes has revealed that treating these people decreases their risk of developing type 2 diabetes by about 60%. Furthermore, in some pre-diabetics, treatment returns their blood sugar levels to normal range.

What’s the treatment for pre-diabetes? Regular moderate exercise; and, for those who are overweight, modest weight loss. Overweight people with pre-diabetes need not reduce to their desirable body weight. They only need to lose five to 10% of their total body weight. Moderate exercise, on the other hand, can come in the form of brisk walking, 30 minutes a day, 5 days a week, or an aerobically equivalent activity.

Other measures that can help pre-diabetics control their blood sugar include a heart-healthy diet and cessation of smoking.

In instances were the above-enumerated measures are unable to reduce the blood sugar levels of a pre-diabetic to normal, physicians often give an oral anti-diabetic drug (i.e., drug that sensitize the person to the action of insulin).       

Managing pre-diabetes offers major health benefits and the earlier the condition is diagnosed and treated, the more effective the treatment becomes. Thus, for early detection of pre-diabetes, people who belong to either of the following categories are advised to undergo screening (i.e., OGTT or FBS determination): 1) those who are 45 years old or older especially if they are overweight; 2) younger individuals who are obese and who have one of the following risk factors for diabetes: A family history of diabetes, dyslipidemia, gestational diabetes, and hypertension. People whose initial pre-diabetes screening yielded normal values need to undergo re-screening only once every three years.

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