What is pre-diabetes and why is it better to control blood sugar starting from the age of 30-35

What is pre-diabetes and why is it better to control blood sugar starting from the age of 30-35


OfElena Meli

The foundation for future cardiovascular health is laid early. Even more so if there are risk factors. At least 4 million people in Italy are pre-diabetes and just as many already diabetic. An epidemic

You don’t get sick of type 2 diabetes from one day to the next, suddenly. We get there with a “long march” that begins many years before the diagnosis, without us realizing it; at a certain point, however, we may realize that we are on a bad path, because we enter a condition of pre-diabetes in which the glycemia it’s still not too high but it’s above the warning level.

The condition

From here it would be possible to go back, with a little effort, and it could save lifebecause when you have pre-diabetes there is a 60 percent greater chance of developing type 2 diabetes but above all the risk of cardiovascular events such as heart attacks and strokes, tumors, kidney or eye diseases.
The people who should slow down the “march” towards a definitive debacle of sugar metabolism are many and often unsuspected: a recent US study has shown that among those with a “healthy” metabolism, according to standard definitions, one in five actually has the metabolism of a pre-diabetic, with blood sugar fluctuations which veer dangerously upwards during the day. This is what happens in people with diabetes, who have many glycemic peaks followed by significant drops in blood sugar: in those with pre-diabetes the peaks are only less acute, but the trend is identical.

The test

The researchers noticed this thanks to continuous glycemic monitoring which allowed them to identify even the less obvious cases of pre-diabetes, but a simple fasting blood glucose test often it is enough to understand if we have taken the wrong path, in order to take action.

The numbers

An epidemic within an epidemic: alongside the four million Italians with diabetes and another million who have it without being aware of it, there are at least others four million fellow citizens with pre-diabetes. According to some estimates, according to which the problem affects at least one in three adults, there could be even more.
It is therefore better not to put your head in the sand, also because to know whether or not the sugar metabolism is out of balance, a simple blood sample is enough to measure the blood sugar level.

Values

Pre-diabetes occurs when the fasting blood sugar is between 100 and 125 mg/dl or if theglycated hemoglobinwhich is indicative of the blood sugar trend in the last two to three months, is included between 5.7 and 6.4 percent; the diagnosis also occurs if one undergoes a glucose “load curve”, drinking a solution of concentrated sugar, and after two hours the blood sugar level is still between 140 and 199 mg/dl (when everything is working as it should, the the action of insulin “sweeps” glucose away from the blood in a short time, allowing it to be stored in the cells). In all these cases, sugar metabolism is altered and the road to type 2 diabetes is paved. «Not only that, the probability of developing a disease is also higher cancer and the risk of having one is about 20 percent higher early cardiovascular disease», specifies Angelo Avogaro, president of the Italian Society of Diabetology (Sid).

The “red flags”

«Since the foundations for future cardiovascular health are already laid around the age of 30, 35, this is also the age at which it is appropriate to start checking blood sugar regularly, as recommended by the most recent guidelines of theAmerican Diabetes Association— continues the specialist —. Especially if there are “red flags” that increase the risk of diabetes, including for example being born underweight or overweightfrom parents with diabetes, or have the cholesterol “good” low HDL ei triglycerides tall, or still have the wide waistline (greater than 88 centimeters in women, 102 in men, ed.), indicative of the presence of a dangerous accumulation of abdominal fat”.

What you risk: 14 years less life

Pre-diabetes is bad, almost as bad as type 2 diabetes of which it is the precursor. And since it accelerates the onset of diabetes, it can as well shorten life expectancy: according to a survey published on The Lancet Diabetes & Endocrinology at the end of the year, juvenile pre-diabetes and a diagnosis of type 2 diabetes by the age of 30 they reduce life expectancy by as much as 14 years. According to this analysis, conducted on over one and a half million people in 19 high-income countries, if you manage to postpone the onset of the disease until around the age of 40, you live on average “only” 10 years less, if the diagnosis arrives at 50 the “cut” is reduced to 6 years; on average, the negative effect on life expectancy is greater in females. «The younger you are when you develop type 2 diabetes, the greater the number
the damages. Recognizing glycemic abnormalities early and intervening to modify them can, however, prevent the long-term complications of diabetes”, conclude the authors.

Who should control themselves

«Even who he is sedentary, overweight or obeseor i hypertensive patients or being treated with medications for high pressure is at risk of pre-diabetes and should control his blood sugar, certainly starting no later than the age of 45, if he has not started doing so before”, adds Riccardo Candido, president of the Association of Diabetologists (AMD). «Those who have already had cardiovascular diseases and all those who have first-degree relatives with type 2 diabetes should also check themselves without delay; Women who have suffered from diabetes during pregnancy or who have given birth to a baby weighing more than four kilos are also at greater risk of developing pre-diabetes. Although there are no obvious gender differences for pre-diabetes, women must pay particular attention because gestational diabetes is a highly dangerous element and because they are overweight more often than men.”

The subtypes

The heterogeneity of risk factors is probably one of the reasons why not all pre-diabetes are the same, at least according to research by the Institute for Research on Diabetes and Metabolic Diseases in Tübingen, Germany, published in Nature Medicine : experts have identified six different types, also different in terms of outcomes.
So for example, those who are obese, have abundant liver fat, tissues resistant to the action of insulin and poor insulin production are part of the subtype 5, with a very high and immediate risk of developing diabetes; has a similar risk the subtype 3, in which there is an increase in blood sugar associated with high insulin production and above all with a clear genetic predisposition. The subtype 6, in which there is a little less liver fat and more insulin is produced, has a more moderate chance of progressing to diabetes, but a high risk of developing kidney and cardiovascular problems. However, there are those who, like the people of subtype 4is overweight or obese but with fat distributed mainly in the subcutaneous tissue and without a significant deterioration in blood sugar: in these cases the probability of progression towards diabetes is lower, as in subgroups 1 and 2 in which overweight is slightly lower and blood sugar levels are less elevated, although above the threshold for the diagnosis of pre-diabetes.

The differences

«The big difference is in the presence or absence of insulin resistance, typical of those who are overweight or obese, or in the reduction of hormone production”, comments Candido. «However, if it is useful for research to understand the mechanisms underlying pre-diabetes, on a clinical and practical level it is best to continue to consider them all equally high risk and intervene by changing lifestyle». «If anything, it may be useful to check whether pre-diabetes is isolated or there is one metabolic syndrome and therefore high triglycerides”, adds Avogaro, “because in this case for example it is more appropriate than ever to reduce dairy products and fruit, given that fructose (also as a sweetener, ed) enters the cells without the need for insulin mediation and stimulates the hepatic production of triglycerides.”

The role of abdominal fat

Diet is essential to combat pre-diabetes, also because it is one of the cornerstones for reducing abdominal fat which “strangles” the internal organs and is particularly harmful to the metabolism. It is no coincidence that a study published recently on The Lancet Diabetes & Endocrinology proved that blood sugar may return to normaland pre-diabetes regress, losing 5 percent of your weight over the course of a year but above all at the level of waistline: those who lose weight elsewhere, perhaps by the same number of kilos, do not obtain the same positive results because tissue resistance to insulin remains high.

Eliminate visceral fat, according to the results, means “curing” from pre-diabetes and interrupting the march towards diabetes, so much so that the risk of falling ill is reduced by 73 percent. Weight management is essential and must involve, in addition to nutrition, an increase in physical exercise because as Avogaro specifies «Even the most virtuous or most rigid diet does not allow you to obtain really good results, if it is not associated with a ‘adequate motor activity. Which, moreover, also helps to indulge in a few more calories at the table.”

Minimal exercise

THE 30, 40 minutes of walking at least five days per week are the minimum; for many, reaching the goal remains difficult because, as Candido admits «the environment in which we live does not help to follow healthy lifestyles and a strong motivation is needed to stay active and not follow wrong dietary models: active policies would be needed to subvert the paradigm , from greater education at school, from early childhood, to interventions to make it more “complicated” to make wrong choices, a bit like what happened with the anti-smoking law which was the first, truly responsible for the reduction in the number of smokers”.

Drugs

There is no escape from a virtuous change in habits, but are there drugs that can be used to help in the task of “blocking” pre-diabetes? “Till today no drugs it is approved with the indication for pre-diabetes therapy”, replies Candido. «However, in numerous scientific studies active ingredients such as metformin, acarbose, pioglitazone have given good results, therefore in selected cases the doctor can decide to prescribe them», concludes the president of the National Association of Diabetologists.

March 23, 2024 (changed March 23, 2024 | 8:30 pm)

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