Diabetes prevention is a major public health concern in Malaysia. Prediabetes is a condition in which blood glucose levels are slightly above normal yet don't reach levels that are diagnostic of Diabetes. Based on the Metabolic Syndrome Study of Malaysia (MSSM) 2008 the prevalence of prediabetes (based on the OGTT) among adults above the age of 18 years was 20% while that of diabetes was 22%.
If untreated, those diagnosed with prediabetes may go on to develop type 2 diabetes within four years. These numbers, as well as the number of children with prediabetes, continue to grow.
Preventive treatment is the most effective for individuals with prediabetes. It is important to understand the condition and the evidenced based diet and lifestyle modifications that improve blood glucose regulation.
Diagnosis
The World Health Organization (WHO) defines prediabetes as IFG between 110 and 125 mg/dL or impaired glucose tolerance (IGT) of 140 to 200 mg/dL after a 75 g oral glucose load. The ADA, on the other hand, uses IFG of 100 to 125 mg/dL, HbA1c of 5.7% to 6.4%, or the IGT as defined by the WHO as diagnostic criteria for prediabetes.
The CPG Primary and Secondary Prevention of CVD define prediabetes when its include any of the following categories:
Impaired fasting glucose (IFG) – FBG: 6.1-6.9 mmol/L
Impaired glucose tolerance (IGT) – 2-hour post load glucose level following oral glucose tolerance test (OGTT) with 75 gm oral glucose between 7.8 – 11.1 mmol/L
Prediabetes – A1c: >5.6 to <6.3%
Who Should Be Screened?
Women with a history of gestational diabetes mellitus (GDM)
Adults who are overweight or obese (BMI ≥23 kg/m2 or waist circumference ≥80 cm for women and ≥90 cm for men) with ANY of the following:
History of CVD
First-degree relative with diabetes
Hypertension (BP ≥140/90 mmHg or on therapy for hypertension)
HDL-C <0.9 mmol/L or TG >2.8 mmol/L
Women who delivered a baby weighing ≥4 kg
Those who were born from mothers with GDM
Physical inactivity and sedentary lifestyle
In those without the above risk factors, testing should begin at the age of 30 years.
If tests are normal, screening should be done annually
Prevention and Treatment
There's research to support the efficacy of lifestyle changes (eg, diet, exercise, weight loss, medications, and supplements) to reverse prediabetes.
Diet
Healthful carbohydrates obviously are preferred, including foods such as fruits, legumes, whole grains, and dairy, but it appears addressing the quantity at each meal is the main concern in reducing postprandial glucose. Overall carbohydrate reduction, with a focus on high fiber intake and tighter glycemic control, is therefore recommended. Dietary pattern that recommended includes the Mediterranean, DASH and Vegetarian diet.
Weight Loss
Those who are overweight and obese are at increased risk of elevated blood glucose. Weight reduction, therefore, is a standard component of lifestyle interventions for improved glycemic control and is one of the most important factors in reversing prediabetes and preventing the progression to diabetes.
Exercise
Exercise is a critical component of an effective lifestyle intervention for prediabetes, as it helps reduce body weight and improves glycemic control. WHO recommended, adults aged 18 to 64 should engage in at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous aerobic activity per week with the addition of strength training at least two days per week.
Supplements
There are numerous vitamins, herbs, and other supplements commonly used to help regulate blood glucose. Their efficacy remains unknown, but there's some evidence of benefit. These include cinnamon, chromium and Omega 3.