What Is Meant by Prediabetes
Approximately 5% to 10% of patients with pre-diabetes develop diabetes mellitus each year. When it comes to risk assessment, family history can be quite useful. Because people who have diabetes mellitus in one or both parents have a six-fold increased risk of having diabetes mellitus themselves.
Type 2 diabetes with over 400 million people throughout the world. AS Per the predictions, the number of people affected will more than treble to almost 1.3 billion in 20 years.
The incidence of tuberculosis has increased rapidly over the last 50 years, with over 90% of those diagnosed with insulin resistance. One out of every two people affected is reported to be completely unaware of the problem.
The term “pre-or early diabetes” has been discussed for about ten years, although it was mentioned in publications as early as 1960. The WHO advocated the designation "intermediate hyperglycemia" and the ADA preferred the "high-risk status for diabetes".
The points of criticism at the time were that some people with prediabetes do not develop diabetes, the term itself leads to the fact that no intervention is necessary and differentiation between prediabetes and various other diabetes risk factors is not absolutely necessary. Univ. Prof. Bernhard Ludvik from the 1st Medical Department at the Rudolfstiftung Hospital in Vienna sees an increased risk of developing diabetes in all of the terms.
In fact, the phrase prediabetes refers to a time prior to the onset of type 2 diabetes during which glucose levels rise but remain below the diagnostic threshold for the disease. As a result, prediabetes diagnosis criteria have evolved throughout time.
It is possible to progress and regress.
The impairment of the function of the beta cells and the increased insulin resistance are two of the pathomechanisms that lead to prediabetes and subsequently to diabetes mellitus. The onset of increased insulin resistance in skeletal muscle occurs many years earlier and can occur before the beta cells are impaired. Five to ten percent of prediabetes patients develop diabetes mellitus each year.
“However, a single value cannot be regarded as definitive,” adds Ludvik. The best would be the OGTT with venous blood sugar values. Since the examination is quite complex, however, one will refer to the increased fasting blood sugar and - which is probably better - to the HbA1c value.
According to Ludvik. Univ. Prof. Friedrich Hoppichler from the internal department at the hospital of the Barmherzigen Brüder in Salzburg recommends a diabetes screening test such as FINDRISK for a better risk assessment before carrying out laboratory tests. If a risk factor is present, the test should be performed at least every three years; In the case of prediabetes, on the other hand, annual testing makes sense. “However, a single value cannot be regarded as definitive,” adds Ludvik.
The best would be the OGTT with venous blood sugar values. Since the examination is quite complex, however, one will refer to the increased fasting blood sugar and - which is probably better - to the HbA1c value, according to Ludvik. Univ. Prof. Friedrich Hoppichler from the internal department at the hospital of the Barmherzigen Brüder in Salzburg recommends a diabetes screening test such as FINDRISK for a better risk assessment before carrying out laboratory tests.
If a risk factor is present, the test should be performed at least every three years; In the case of prediabetes, on the other hand, annual testing makes sense. “However, a single value cannot be regarded as definitive,” adds Ludvik. The best would be the OGTT with venous blood sugar values.
Since the examination is quite complex, however, one will refer to the increased fasting blood sugar and which is probably better - to the HbA1c value, according to Ludvik. Univ. Prof. Friedrich Hoppichler from the internal department at the hospital of the Barmherzigen Brüder in Salzburg recommends a diabetes screening test such as FINDRISK for a better risk assessment before carrying out laboratory tests.
If a risk factor is present, the test should be performed at least every three years; In the case of prediabetes, on the other hand, annual testing makes sense. Friedrich Hoppichler from the internal department at the Barmherzigen Brüder Hospital in Salzburg recommends a diabetes screening test such as for a better risk assessment before laboratory tests are carried out.
Although not all of the mechanisms of diabetes mellitus are fully understood, some genetic and epigenetic variables are known to play a significant influence. About half of all patients with diabetes mellitus are obese with a BMI> 30; most are overweight with a BMI> 25. L.
Ludvik recommends factoring in the trunk-weighted fat distribution when calculating risk. The number of adipocytes, cytokines, interleukins, and TNF-alpha in the body increases as a result of obesity. All of these elements cause the adipose tissue to become inflammatory.
which promotes insulin resistance via chronic subliminal inflammation. A lack of exercise and the associated predominantly sedentary lifestyle are some of the main reasons why diabetes mellitus occurs. Of all the activities that are carried out while sitting, watching TV has the lowest metabolic rate. If you only replace 30 minutes of sitting with moderate to vigorous activity, insulin sensitivity can be improved by up to 15 percent.
Excessive alcohol use increases the chance of developing type 2 diabetes. More than 63 grams of alcohol consumed each day has been linked to an increased risk of hypertension. In addition, smokers are more likely to acquire diabetes mellitus. So according to studies, smoking 15 cigarettes per day increases the risk of diabetes by 61%; smoking less than 20 cigarettes per day reduces the risk of hypertension by 61%.,
Because nicotine is an insulin-sensitive chemical, wearing nicotine patches carries an elevated risk. Furthermore, nicotine can cause apoptosis in beta cells in the pancreas, resulting in a decrease in beta-cell mass overall. Normal-weight smokers had higher belly fat than nonsmokers, according to researchers, which is high blood glucose and prediabetes.
Since both diseases have a similar or partially the same etiology and disease mechanisms, cause and consequences are difficult to analyze. "With regard to an increased risk of cardiovascular diseases, which are associated with prediabetes, one must also consider the influence of the normally associated risk factors such as hypertension and hyperlipidemia or dyslipidemia," says Ludvik. Thus, patients with cardiovascular risk factors and/or manifest cardiovascular diseases are the group who have an increased risk of prediabetes and should be screened accordingly.
Even in people with prediabetes, there are significantly more plaques in the vessels. The average intima-media thickness is also significantly higher than in patients with normal glucose values. Echocardiographic examinations show early signs of diastolic dysfunction in patients with prediabetes significantly more often.
Reduced heart rate variability and a threefold increase in the prevalence of erectile dysfunction in men have also been described in connection with prediabetes. It can therefore be assumed that people with pre-diabetes may already have damage in end organs such as eyes, kidneys,
blood vessels, and the heart. Early stages of nephropathy and chronic kidney disease with albuminuria are found in prediabetics as well as neuropathies. Vascular changes in the area of the retina are also likely to develop early; however, the data for this is not yet uniform and varies according to the investigation method.
Age, gender, and origin also play a role in the development of diabetes mellitus. The risk of developing prediabetes increases significantly from the age of 45. The highest prevalence is found in the 65 to 74 age group.
Pathophysiologically, this fact can best be explained by the decreasing insulin sensitivity with increasing age. In addition, the beta cells change and produce less insulin as people get older. With regard to gender, women are more likely to have impaired glucose tolerance,
while men are more likely to have increased fasting glucose. In principle, more men - especially at a younger age and with a lower BMI - have diabetes mellitus than women. The cause of this imbalance has not yet been fully clarified. In women, however, there are increased inflammation parameters, less favorable changes in the coagulation system, and higher blood pressure values in both prediabetes and diabetes mellitus. The body fat distribution is also likely to play a role
since men are more likely to have higher proportions of visceral fat and liver fat than women with the same BMI. In contrast, women with gestational diabetes have a history of developing overt diabetes mellitus almost twice as often as women with comparable values for insulin resistance, body weight, and glucose tolerance without gestational diabetes. Therefore, women who have gestational diabetes should be screened for diabetes every three years.
The risk increases from the age of 45
Diabetes mellitus is influenced by factors such as age, gender, and ethnicity. From the age of 45, the chance of acquiring prediabetes rises dramatically. The age range 65 to 74 has the highest incidence. This fact is best explained pathophysiologically by the fact that insulin sensitivity decreases with age.
Furthermore, as people age, their beta cells alter and generate less insulin. Women are more likely than males to have impaired glucose tolerance, but men are more likely to have elevated fasting glucose. In theory, men are more likely than women to get diabetes, especially when they are younger and have a lower BMI. The cause of this imbalance has yet to be determined.
In women, however, there are increased inflammation parameters, less favorable changes in the coagulation system, and higher blood pressure values in both prediabetes and diabetes mellitus. The body fat distribution is also likely to play a role since men are more likely to have higher proportions of visceral fat and liver fat than women with the same
BMI. In contrast, women with gestational diabetes have a history of developing overt diabetes mellitus almost twice as often as women with comparable values for insulin resistance, body weight, and glucose tolerance without gestational diabetes. Therefore, women who have gestational diabetes should be screened for diabetes every three years.
Regardless of gender, ethnicity also plays an important role. People of non-Caucasian origin are at increased risk of developing diabetes mellitus. A family history, especially in the case of first-degree relatives, can provide essential information for a risk assessment, since people whose parents have diabetes have a six-fold higher risk of developing diabetes mellitus as well. More than 40 genes such as CAPN10 and ACRP30 have so far been identified as responsible in this context, but gene regions such as PPARG and KCNJ11 are also linked to the occurrence of diabetes.
Basically reversible Prediabetes is a fundamentally reversible condition, so measures should be taken at the latest when the diagnosis is made. Both experts recommend annual check-ups for patients with pre-diabetes in view of their risk factors and possible long-term effects.
"A lifestyle modification with a reduction in the most existing overweight and a change in diet in the sense of a Mediterranean diet, albeit with complex carbohydrates, as well as increased physical activity in everyday life and through sport are the most important measures," emphasizes
. Physical activation improves insulin sensitivity through the oxidation of free fatty acids, improves mitochondrial function in skeletal muscle, and reduces lipotoxicity in skeletal muscle and the liver. In addition, the serum content of adiponectin is increased and the uptake of glucose in the muscle cells is increased. Hoppichler refers to a number of large diabetes prevention studies in which the effectiveness of lifestyle measures in preventing the manifestation of type 2 diabetes has been confirmed.
"In the Diabetes Prevention Study and in the Diabetes Prevention Program, lifestyle interventions, as well as medicinal measures, achieved a reduction in diabetes manifestations," said Hoppichler. Lifestyle modifications have been found to be particularly effective in women and the elderly.
0 Comments