Prediabetes Diagnosis

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Pre-diabetes diagnosis is by blood sugar tests, if your number is higher than most young-healthy people has, then you are diagnosing as prediabetes. Prediabetes also called as borderline diabetes and impaired glucose tolerance (IGT) or impaired fasting glucose (IFG), depending on which test has used to detect it.

Are you required screening for pre-diabetes?  

Based on the diabetes risk factors, certain standard is set for pre-diabetes screening criteria.

Criteria for prediabetes screening are:

  • More than two diabetes risk factors,
  • Central obesity,
  • Have had gestational diabetes,
  • Have had a poly-ovarian cyst,
  • Already have a blood-glucose higher end of the normal range,
  • Presence of diabetes symptoms,
  • Have high blood pressure,
  • Have high blood cholesterol.

If you met most of the above-said criteria, then you require undergoing for pre-diabetes screening.

How is pre-diabetes diagnosed?

Blood tests are used to diagnosis pre-diabetes. They are fasting blood-glucose test, oral glucose tolerance test, and glycated hemoglobin A1C test. 

What is the pre-diabetes number? The blood-glucose range is higher than normal but not high enough to diagnose as diabetes. 

Pre-diabetes chart

  • Fasting Plasma Glucose (FPG) – is a blood-glucose test taken after not having anything to eat or drink (except water - even do not drink a lot of water before the test) a minimum of eight hours before the test. This test is conveniently carryout in the morning, before breakfast. Confirm pre-diabetes if BS is 100 mg/dl to 126 mg/dl (or 5.56 to 7 mmol/L) also known as impaired fasting glucose.
  • Oral glucose tolerance test (OGTT) – or glucose challenge test is a blood-glucose test before, one-hour and two hours after you eat a carbohydrate-rich food or drink a special sweet drink. Confirm pre-diabetes if BS is 140 mg/dl to 199 mg/dl (or 7.77 to 11 mmol/L) also known as impaired glucose tolerance.
  • Glycated hemoglobin test (A1C) – is a test done at any time, there is no fast or drink anything, and it measures the average BS for the past two to three months. Confirm pre-diabetes if the A1C is 5.7% to 6.4%.

What is Impaired Fasting Glucose (IFG) & Impaired Glucose Tolerance (IGT)?

Both IFG & IGT are insulin-resistance. People with IFG along have hepatic insulin resistance and optimal muscle insulin sensitivity. People with IGT alone have been normal to slightly reduced hepatic insulin sensitivity and moderate to severe muscle insulin resistance. People with both IFG & IGT possess both muscle and hepatic insulin resistance; they have about double the chances to develop diabetes than people with just one of them.

What test is preferable in early pre-diabetes diagnosis?

A study "Impaired fasting glucose or impaired glucose tolerance, what best predicts future diabetes in Mauritius," was published in Diabetes Care March 1999 vol. 22 no. 3 399-402. It shows the higher sensitivity of IGT over IFG for predicting progression to type2 diabetes. Screening by the criteria for IFG alone would identify fewer people who subsequently, progress to type2 diabetes than would be the oral glucose tolerance test.

Numerous studies show both IFG & IGT has been associated with a modest increased risk towards CVD, with IGT being a slightly stronger risk predictor. Intensive lifestyle chances can help delay or prevent diabetes and risk factors for CVD.

Thus, it is always preferable to take both IFG & IGT (is particularly important) in the same day or alternate day to predict pre-diabetes in the early stage. 

Is it possible, to “reset the clock” or altered the rate of progression of diabetes?

A study shows the natural history of both IFG and IGT is variable; with 25% progressing to diabetes, 50% remaining in their abnormal glycemic state, and 25% reverting to NGT (normal glucose tolerance) over an observational period of 3 to 5 years. Individuals who are older, overweight, and have other diabetes risk factors are more likely to progress. Moreover, low insulin secretion and severe insulin resistance identify individuals more likely to progress to diabetes.

The lifestyle modification studies were associated with any untoward effects. Instead, they are having other health-related benefits. Lifestyle modification therapy with modest weight loss (5–10% of body weight) and moderate-intensity physical activity (about 30 minutes daily) is the treatment of choice for people with IFG/IGT. Metformin was the first drug shown to be effective; however, it is just about the half of that of lifestyle modification.

It is possible; you will be one in this 25% reverting to NGT group, best of luck!

Change your lifestyle, when your numbers are in unhealthy range.

The popular institutions set ranges for healthy, pre-diabetes and diabetes based on the old study that say one who has knowingly diagnosed as pre-diabetes progress to diabetes early due to mental strain. The ranges have shifted to the higher end for this reason. However, prolong unhealthy blood glucose level can lead to diabetes complications even if not progress to diabetes.

However, many health professionals think their patients are intelligent, smarter, and brave enough. Therefore, the patients are stronger to take challenge and considering it as an alarm in preventing diabetes. 

The actual unhealthy blood-glucose numbers are as below:  

  • Fasting blood-glucose level over 90 mg/dl (or 5.00 mmol/l)
  • One hour after meal level over 125 mg/dl (or 6.94 mmol/l)
  • Two hours after meal level over 110 mg/dl (or 6.11 mmol/l)
  • Five hours after meal level over 90 mg/dl (or 5.00 mmol/l)

If your blood-glucose number is in the unhealthy range, then take this alarm towards prediabetes & diabetes. Take necessary steps to prevent its progression as well as stop diabetes complications.

The early intervention help delays the onset of diabetes. Additionally, preserving beta-cell function, and delay the likelihood of micro vascular, and cardiovascular complications.

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