With the improvement of living standards and changes in lifestyle, the prevalence of diabetes is increasing rapidly. At present, the prevalence of diabetes among adults in my country is 11.6%, and the population with diabetes and prediabetes is as high as more than 50%. In other words, one in every two adults around us is a patient with prediabetes.
Without timely intervention, it is highly likely that these diabetic reserves will join the diabetes ranks in the future. Some people may ask, how to define prediabetes? What are the potential hazards of prediabetes? How should I intervene? Below, we discuss these issues.
How is prediabetes defined?
Pre-diabetes is a transitional state in which blood sugar is higher than normal but not yet diagnostic criteria for diabetes.
We know that normal fasting blood sugar
According to the above definition, fasting blood glucose is between 6.1 and 7.0 mmol/L and/or 2 hours postprandial blood glucose is between 7.8 and 11.1 mmol/L. High blood glucose is also called impaired fasting glucose (IFG), and high postprandial blood glucose is called impaired glucose tolerance (IGT).
In general, over 45 years of age, family history of diabetes, metabolic syndrome (obesity, hypertension, hyperlipidemia, fatty liver, etc.), gestational diabetes or macrosomia Those with a history of diabetes are high-risk groups of diabetes, and these people should be screened for diabetes every year.
Are patients with prediabetes clinically symptomatic?
The symptoms of prediabetes are very insidious. Most patients only show slightly elevated fasting blood glucose or impaired glucose tolerance, and some patients show hypoglycemia before meals, for example, often at noon Or the symptoms of hypoglycemia such as palpitation and tremors when eating fast at night are related to the delayed peak of insulin secretion in patients.
Because of the lack of typical “three more and one less” symptoms, it is difficult to detect symptoms from the symptoms. Therefore, most patients with prediabetes are found unintentionally during physical examination.
It should be emphasized that most patients with prediabetes firstly increase postprandial blood sugar, and then fasting blood sugar begins to increase. Therefore, screening for diabetes should not only check fasting blood sugar, but also at the same time Check blood sugar 2 hours after a meal, otherwise, nearly 2/3 of prediabetic patients will be missed.
Why is prediabetes so important?
Pre-diabetes isn’t quite the same as diabetes, and it’s often asymptomatic, but it’s also not something to be taken lightly. This is because:
(1) The harm caused by high blood sugar to the body does not start from the day of being diagnosed with type 2 diabetes. In fact, as early as prediabetes, with the gradual increase in blood sugar, the body has already begun to be damaged, which is why many patients have macrovascular disease (coronary heart disease, stroke, lower extremity vascular disease, etc.) when they are diagnosed with type 2 diabetes. );
(2) Pre-diabetes is a transitional period to diabetes. If there is no intervention and it is allowed to develop, the vast majority of these “reserve troops” will develop into “regular troops” sooner or later. is very worrying. Therefore, we must attach great importance to the early intervention of prediabetes, and its significance is no less than the treatment of patients with existing diabetes.
Fortunately, prediabetes can be reversed, and with early aggressive intervention (mainly lifestyle intervention), the risk of developing diabetes can be significantly reduced, which has been well-known China Daqing Research Institute confirmed.
Is it necessary for people with prediabetes to take medication?
It has been demonstrated that both lifestyle and pharmacological interventions can prevent the transition from prediabetes to type 2 diabetes.
The Daqing Diabetes Prevention Study completed by Chinese scientists confirmed that lifestyle intervention for people with impaired glucose regulation for about 3 years can reduce the risk of type 2 diabetes in those with impaired glucose regulation about 60%;
American scholars have used the method of drug (metformin) intervention, with an average follow-up of 3 years, and confirmed that it can reduce the risk of type 2 diabetes by 25% to 30% in people with impaired glucose regulation.
These studies at home and abroad have given us two important lessons:
First, the natural course of diabetes can be reversed. If active intervention can be carried out in the pre-diabetic stage, it is entirely possible to delay or even terminate the occurrence of diabetes;
Second, lifestyle intervention not only costs less and is safer, but also has better effects than drugs.
How do lifestyle interventions work?
(1) Keep your mouth shut
To prevent diabetes, you must keep your mouth shut. You can’t eat too much or eat indiscriminately, but you don’t need to be afraid to eat anything like an ascetic. Instead, you should pay attention to moderate calorie intake and balanced nutrition.
Eat seven or eight full meals, eat more fresh vegetables, limit sweets and sugar-sweetened beverages (such as chocolate, ice cream, cream cakes, snacks, juices, carbonated drinks, etc.), eat less large Fish, meat and fried foods, these high-fat foods contain high calorie and cholesterol, it is easy to make the calorie intake exceed the standard, resulting in the body gaining weight and blood lipids risinghigh.
Many studies have confirmed that long-term sedentary lifestyles are associated with the onset of diabetes, which has also sounded the alarm for office workers and game fans who sit in front of computers all day.
In order to stay away from diabetes, be sure to get yourself moving, take at least half an hour every day to exercise and do aerobic exercise, which can not only consume excess body fat and energy, but also Improve insulin resistance and lower blood sugar.
(3) Weight Control
The diagnostic criteria for obesity is based on body mass index and waist circumference. Body mass index (BMI, weight in kilograms divided by the square of height) ≥ 24 kg/m2 is overweight; ≥ 28 kg/m2 is overweight obesity. Waist circumference ≥ 90 cm in men and ≥ 85 cm in women is called abdominal obesity.
Obesity, especially abdominal obesity, is strongly associated with type 2 diabetes and is an independent risk factor for type 2 diabetes, with a 4 times higher risk of developing diabetes than normal-weight people. The benefits of weight control are not only lower blood sugar, but also blood pressure, blood lipids, uric acid and fatty liver.
The key to weight control is to keep your mouth shut and your legs out. For pre-diabetic patients with severe obesity (BMI ≥ 32.5 kg/m2), if lifestyle interventions are not effective, metabolic surgery (gastric bypass or gastric sleeve resection) can be considered to reduce weight to improve glucose metabolism disorders.
(4) Learn to decompress yourself
Modern society is full of competition and pressure, and long-term mental stress will stimulate the secretion of adrenaline, glucocorticoids and other blood sugar-raising hormones to increase, resulting in increased blood sugar, which is also the cause of the high incidence of diabetes in today’s society and the One of the reasons for getting younger.
Therefore, it is necessary to learn to combine work and rest, relax in moderation, self-decompression, and relax.
(5) Don’t stay up too often
Some people often stay up late because of bad habits such as work or watching TV. This is not a good habit. A study by the University of Warwick found that people who got less sleep had a 28% higher risk of developing diabetes than those who got 6 to 8 hours of sleep per night.
Don’t sleep when it’s time to go to bed, the body’s biological clock is disrupted, the circadian rhythm of hormones in the body is disrupted, and the released glucocorticoid will aggravate the state of hyperglycemia. Therefore, try to work and rest regularly and ensure 7-8 hours of sleep every day.
When is pharmacological intervention needed?
Lifestyle changes are often easier said than done. If pre-diabetic patients are difficult to adhere to, or simply relying on lifestyle improvements cannot correct the disorder of glucose metabolism, in this case, drug intervention can be considered.
At present, the drugs that have been confirmed by evidence-based medicine for pre-diabetic intervention include: acarbose and metformin. Pre-diabetic patients with high blood sugar can choose acarbose.
In addition, for obese patients with prediabetes, GLP-1 receptor agonists (such as liraglutide, semaglutide, etc.) Weight loss improves the patient’s insulin resistance and achieves the purpose of preventing diabetes.
Pre-diabetes is, in a sense, the patient’s last chance for redemption. As long as you can persevere and adhere to a healthy lifestyle, it is entirely possible to block the development of diabetes, or even reverse the disease, and your health is in your own hands.
This article is intended for healthcare professionals and other professionals
Planning | Dai Dongjun
Title map | Station Cool Hero
Prevalence and Treatment of Diabetes in China, 2013-2018. JAMA. 2021 Dec 28;326(24):2498-2506. DOI: 10.1001/jama.2021.22208.