Therefore my recommendations are:

AND Also all overweight(85th percentile weight and above) adolescents of above 10 yrs of age, should be subjected to active screening ,because with “soon arriving” puberty and hormonal changes/surges ,this age group will not give you enough time for interventions while progressing from Pre-Diabetes to Diabetes, in fact within few months the damage and progress to Diabetes may be complete and the Intervention phase for Pre-diabetes gets totally missed /lost in the process !

Pleasantly even Americans are waking up to the idea of proactive search and drug treatment of PredIabetes as indicated by many recent publications.

Pre Diabetes- FAQs

Q1:What is meant by Pre-Diabetes?

Ans: This is a Biochemical abnormality which may be a precursor for Diabetes that’s why the name is given as that.

Q2.How do we clinically define it? How it can be detected?

Ans: The tests for detection of Diabetes and Pre-Diabetes are exactly the same, it is the extent of abnormality which differentiates them into two different classes. This is as under:

Fasting Blood Glucose Normal Below 100 mg %(70-100)

Diabetes Above 126 mg%

Then there is a gap!

What will you say for the Glucose Levels from 101 to 125 mg% ?

This is called as Impaired Fasting Glucose OR IFG- in short

Now, there is another way of Diagnosing Diabetes and that is, when you get Post-meals Glucose levels of 200mg% or above OR we put a challenge load of 75 Gms. of Glucose on to the system and at Two Hrs, if Glucose levels cross 200 mg %.This 200 mg % is set as the limit above which we label the patient as Diabetic..

But coming back to the levels for- after meals or at 2Hrs after 75 Gms of Glucose load, we know the Normal upper limits are 140 mg%!

So again, there is gap here, from 140 of the normal limits to 200 mg% ,a point where Diabetes starts, there is this category, from 141 to 200 mg%

what we call as Impaired Glucose Tolerance OR IGT- in short !

To summarize now-

Normal levels Fasting 70-100 mg%

Post meals <140 mg%

Diabetes means Fasting Bld Glucose ----126 mg% & above

OR at 2 Hrs After meals ------ 200 mg% & above

OR at 2Hrs After 75 G Glucose load —Above 200 mg%

IFG OR Impaired Fasting Glucose 101 to 125 mg% *

IGT OR Impaired Glucose Tolerance 141 to 199 mg% *

**Both these later categories of IFG & IGT put together are called and categorized as Pre-Diabetes by most of the clinicians.

Q3. What are the Risk Factors for Pre-Diabetes:

Ans : RISK FACTORS FOR PRE-DIABETES ARE

There are a number of risk factors which significantly increase the likelihood of the disease's onset. These are:

♦ a family history of Type 2 Diabetes or heart disease

♦ being overweight or obese

♦ being aged 45 or older

♦ suffering from hypertension (high blood pressure)

♦ belonging to a high-risk ethnic group, namely African-Americans, Asian-Americans, Latinos or Pacific Islanders

♦ being "apple-shaped" rather than "pear-shaped," meaning that excess weight gathers around your waist, rather than your hips

♦ if female, suffering from Gestational Diabetes while pregnant or giving birth to a baby weighing more than 9 lbs

♦ eating an excess amount of carbohydrates

♦ leading a sedentary lifestyle with little or no exercise

♦ being recently diagnosed as suffering from Insulin Resistance

Researchers have found a link between Pre-Diabetes and other conditions such as the cluster of cardiovascular diseases called Metabolic Syndrome (Syndrome X), as well as the hormonal imbalance called Polycystic Ovarian Syndrome (PCOS), which is a major cause of female infertility. Research has indicated that up to 40% of women with PCOS suffer from Pre-Diabetes or Type 2 Diabetes by the age of 40.

Q4.Why all this effort of creating yet another category of ab-normals out of Normals ? If you are Not Diabetic then you are Normal !Why at all Prediabetes should be created from within the Non Diabetics ? What is the logic behind this?

Ans: We have solid scientific evidence which tells us that Risk For Cardiovascular complications in terms of Heart attacks, Brain attacks or Strokes, Peripheral Vascular Disease ,Impotence and Non alcoholic Steatosis and Steato-hepatitis(linked to fatty liver) which can end up as permanent Liver damage, all start YEARS before Diabetes actually arrives on the scene !

And you know 35% to 40% of Pre-diabetes can actually progress to Diabetes. I can therefore put forward the following reasoning For Pre-diabetes being created as a separate condition:

♦ This category is clearly linked with High complications risk for all the above deadly conditions!

♦ This category can progress to Diabetes.

♦ Diagnosis of Prediabetes needs NO EXTRA effort. You are actually doing the same tests for the Diagnosis of Diabetes and only in the process, you encounter thesePre-diabetics !AND while screening for Pre-Diabetes you may by chance, find out few cases of UNDIAGNOSED Diabetes as well !A very real possibility.

♦ We can do a lot for these people through appropriate interventions including Drugs, for this particular category.

♦ AND above all - We have solid evidence, again, that these interventions

DO MAKE DIFFERENCE ! and a world of difference! We can reduce overall risk for all the complications mentioned above and also can revert OR at least slow down & delay the progress to Frank Diabetes !

DO MAKE DIFFERENCE ! and a world of difference! We can reduce overall risk for all the complications mentioned above and also can revert OR at least slow down & delay the progress to Frank Diabetes !

Q4: So this seems to be logical then; but what are the recommendations for Health care people and masses in general?

Ans: Keeping in view the latest International Diabetes Federation’s recommendations and also the rising trends of Diabetes, Heart attacks., Strokes, Impotence and NASH-(Non Alcoholic Steato-hepatitis –a Liver damaging situation linked to Fatty liver ),we need to actively and aggressively look for it’s presence in our populations. We should also not forget that Indians ,as a race are already genetically prone to all these conditions ,which tend to occur earlier by TEN years to us and then progress rapidly thereafter! For all the right thinking and really concerned Health Care Individuals this should be their DUTY to Pro-actively look for Pre-Diabetics-“A stitch in time saves NINE”

Therefore my recommendations will be :

For all Indian Individuals above 35 yrs of Age it should be mandatory to Test for Fasting Blood Glucose and for Post Prandial Glucose at TWO hrs after 75 Gs of Glucose load and if found normal then it should be repeated at every 2 yrs!

Adolescent Overweight and Obese-Diabetes in Children ! Overweight(85th percentile weight and above) adolescents of above 10 yrs should also be subjected to active screening ,because with “soon arriving” puberty and associated hormonal changes ,this age group will not give you enough time for interventions while progressing from Pre-Diabetes to Diabetes, in fact within few months the damage and progress to Diabetes may be complete and the Intervention phase of Pre-diabetes gets totally missed and lost in the process !