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Prediabetes – the Silent Enemy

September 13, 2018 By Helly Bartolome Hernandez Marin, M.D

[Image 1] With the growth of the population, changes in lifestyle, obesity, and other risk factors, diseases such as diabetes mellitus type 2 (DM2) and cardiovascular events have increased in parallel; both entities can occur independently or interrelated. DM2 is considered a public health problem, given its high prevalence and its accelerated increase in the last 20 years. The World Health Organization (WHO) has indicated that this increase can be up to 160% in the next 25 years. The support of epidemiological studies and the knowledge that it is possible to identify DM2 in an asymptomatic stage has allowed the development of early detection strategies with economic, simple, and sensitive diagnostic procedures, allowing timely prevention measures.

Prediabetes is a condition that precedes the diagnosis of type 2 diabetes and is characterized by an elevation in the concentration of sugar (glucose) in blood beyond normal levels without reaching the diagnostic values of diabetes. It is identified by evidencing alterations in the oral glucose tolerance test (140-199 mg/dl) and the change in fasting blood glucose values (100-125 mg/dl).

The evolution of prediabetes to type 2 diabetes can be avoided. Consuming healthy foods, incorporating physical activity into your daily routine, and maintaining a healthy weight can help you regulate your blood sugar level.

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Symptoms of prediabetes

Prediabetes is a condition that often goes unnoticed because it usually does not present evident symptoms. However, the main symptoms in people with prediabetes are found below.

Blurred vision: Sudden rises and falls in blood sugar levels (common in people with pre-diabetes) can affect the ability of the eye to focus, which results in blurred vision. Once the sugar levels are regulated, this symptom should disappear.

Excessive thirst: When there is excess sugar in the blood, the body eliminates it through urine, which prompts the need to go to the bathroom more than usual. That, in turn, causes dehydration which produces excessive thirst.

Wounds or infections that take a long time to heal: High levels of blood sugar slow down circulation, so the skin needs more time to heal itself. Therefore, small bruises and cuts take longer than normal to heal. Pre-diabetes can also promote the growth of bacteria and fungi, which lead to recurrent infections in the skin, vagina and or urinary tract.

Fatigue: Your body uses sugar in the blood as fuel, but prediabetes causes insulin resistance, which makes your body unable to convert glucose into energy efficiently. Consequently, you feel fatigue and excessive fatigue.

Skin areas darken: Some people with prediabetes may show signs of insulin resistance. High insulin accelerates the speed of reproduction of skin cells, resulting in pigmentary acanthosis. This happens when the skin of the neck, under the arm, or in the folds of the elbows begins to darken.

Unexplained weight gain or loss: When the body cannot get the energy it needs from blood glucose, it starts burning other things for energy which can cause sudden weight loss even if you do not diet or exercise. However, insulin resistance can also make the patient hungry and gain weight.

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Several clinical trials have been published regarding the treatment of prediabetes to investigate the effectiveness of these treatments in delaying or abrogating the progression of prediabetes to diabetes. In general, the studies provide optimistic data and establish that: 1) lifestyle changes are highly effective in slowing the progression of prediabetes to diabetes, and 2) pharmacological agents that increase insulin sensitivity (metformin, glitazones) or prevent the absorption of carbohydrates (Acarbose) also confer a delay effect in the progression of prediabetes to diabetes.

In a simplified form, the treatment of individuals with prediabetes primarily includes the change in lifestyle, with the goal of weight loss and increasing daily physical exercise. If these measures do not have the desired effect in a reasonable time, then medication treatment should be supplemented. This treatment scheme is fluid, especially taking into account the recent data obtained in the treatment with pioglitazone, where there is evidence of an 82% decrease in the incidence of diabetes in individuals treated with this drug.

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