There are at least 77 million people with diabetes in India, and an equal number are expected to be living with pre-diabetes, according to the National Center for Biotechnology Information (NCBI)’s 2021 review Epidemiology of type 2 diabetes in India. In fact, approximately 25 per cent of the people with pre-diabetes will progress to overt type 2 diabetes within 3–5 years, notes NCBI’s 2019 review Global epidemiology of pre-diabetes – present and future perspectives.
For the unversed, pre-diabetes or borderline diabetes is a medical condition where the blood sugar level is elevated but is not as high as in diabetes. This is why, experts stress the need for clasping pre-diabetes to ease the burden of this metabolic disease that is now being detected even in teens and people in their twenties, especially in the post-Covid world, owing to preventive screenings, experts note.
“Yes, post-Covid, we saw a lot of young patients coming with borderline diabetes,” said Dr Kavitha S, consultant family physician, diabetologist, and geriatrician, Sparsh Hospital.
Sharing that the normal fasting blood sugar level is 99 mg/dl or less, Dr Paula Goel, consultant paediatrician, adolescent physician and founder, Fayth Clinic told indianexpress.com, “pre-diabetes is when the blood-glucose range is between 100 to 125 mg/dL, while levels above 126 mg/dL indicate diabetes.”
What are the causes?
The main reasons for pre-diabetes in a post-Covid world, according to Dr Kavitha, range from a sedentary lifestyle to stress and disturbed sleep patterns. “Indians thrive among many high-risk pre-diabetic conditions. Family history does not have to be the necessary cause. A lot of young patients come with high sugar levels these days (above 300). Everyone should have an understanding of what exactly pre-diabetes is and get their sugar levels checked regularly. Pre-diabetes has no age limit. Previously, patients above 30 years old used to get their cholesterol and sugar levels checked yearly. In recent times, young adults, above the age of 20, should also get their sugar levels checked,” Dr Kavitha told indianexpress.com.
She elucidated further:
Sedentary lifestyle: Work from home being the main concern, sitting for 10-12 hours daily with no physical activity or restricted activities.
Eating habits: Irregular eating timings and habits such as late-night meals with high-calorie intake. Such habits tend to increase sugar levels and weight.
Work stress: Working for long hours with no breaks in between
Sleep pattern: Change in sleeping pattern or lack of sleep.
Quantity and quality of food: Regularly consuming processed and packaged foods with high calories will inevitably lead to a rise in sugar levels in the body.
Persons with pre-diabetes may or may not be symptomatic. “They may present with increased thirst, increased urination, weight gain, or weight loss, headache, giddiness, sweating, blurred vision, and fatigue,” said Dr Paula.
How is it detected?
Dr Paula shared that pre-diabetes is detected by testing HbA1C levels, which measures blood sugar levels over the previous three months, with a reading between 5.7 and 6.4 per cent. “A normal A1C level is below 5.7 per cent; a level of 5.7 per cent to 6.4 per cent indicates prediabetes; and a level of 6.5 per cent or more indicates diabetes,” Ashoka Fellow Dr Nalini Saligram, founder and CEO, Arogya World said.
Tests to detect blood sugar in India
Dr Rajesh Bendre, chief pathologist, Neuberg Diagnostics listed the tests
A1C test: It is also called the HbA1C test. You can assess your average blood sugar levels over the previous two to three months using this quick blood test.
Fasting blood sugar test: This test, as its name implies, assesses blood sugar levels following a night of fasting (not eating anything for at least 8-10hrs). Blood sugar fasting – below 100 is normal, 100 to 125 mg/dL indicates prediabetes, and 126 mg/dL or higher indicates diabetes.
Glucose tolerance test: A glucose tolerance test (GTT) evaluates the body’s capacity to handle blood sugar (glucose). It entails comparing the blood glucose levels before and after consuming a sugar (75gms) as a loading dose.
Random blood sugar test: This is similar to a fasting blood sugar test except this, it can be done at any random time.
Why should it be detected early?
Experts urge early detection can reverse pre-diabetes and prevent the long-term complications of diabetes that can result in heart attack, stroke, eye issues, and kidney damage among others. “The window of a few years in pre-diabetics before the onset of diabetes can be the best time to intervene so that we can prevent diabetes and secondary complications of uncontrolled diabetes in the future, such as heart disease, stroke, kidney disease, foot amputations, blindness etc. In the Covid era, this prevention has become more urgent and important than ever before because we know that people with diabetes, hypertension, obesity and non-communicable diseases are the ones needing hospitalisation, and intensive care units, and are the ones least likely to survive the viral respiratory ailment,” Dr Nalini told indianexpress.com.
Unlike the name, pre-diabetes can progress faster if not managed effectively, warned registered dietitian Garima Goyal. “Early lifestyle and dietary intervention can make the progression of the disease more manageable and reduce complications,” she told indianexpress.com.
Treatment and lifestyle interventions
“Pre-diabetes has all possibilities to progress to diabetes. But with the right intervention, you can alleviate the complications and, in some cases, even reverse them,” said Garima, as she shared the following measures to nip prediabetes in the bud:
Reducing weight: Research says that weight loss of about seven per cent (of total body weight) has improved the overall management of diabetes. You may reap better results if you could focus on both nutrition and exercise for promoting weight loss.
A nourishing diet: A healthy and wholesome diet rich in fibre, vitamins, and minerals will help in maintaining your insulin sensitivity. Including more nutrient-dense foods will help you in your goal of reversing diabetes.
Starting exercise: Pre-diabetics should become ‘stairs-people’. Start involving in different physical activities from day 1 and progress to daily exercise routines. Exercise helps in the efficient use of glucose by cells and also improves insulin sensitivity.
Managing stress: Though stress is not the only contributing factor, it can still propel your progression to diabetes. Handling stress effectively through some management techniques will be beneficial.
Additionally, Dr Kavitha noted
Regular sleep cycle: Every individual must get for 6-7 hours of continuous sleep per day and give their body enough rest and time to function well.
Addictions (alcohol, smoking, drugs) play a major role in the development of pre-diabetes and diabetes, and must be avoided, Dr Kavitha added.
Dr Kavitha listed the following pointers that can help prevent pre-diabetes
Diet: Following a strict diet is necessary. One must avoid food rich in carbohydrates. Individuals must eat home-cooked meals and avoid processed foods. “Even if one cannot stop eating junk food, they have to reduce their intake or can consume it once or twice a month,” Dr Kavitha said.
Physical activity: According to the guidelines, 150 mins per week of physical activity is a must for every individual to prevent prediabetes. Doctors recommend a minimum of 30 mins of physical activity (walking, jogging, exercise, swimming etc).
Regular sleep cycle: Every individual must sleep for 6-7 hours of continuous sleep per night and give their body enough rest and time to function well.