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The Star Online: Lifestyle: Health

Borderline sugar alert!

Posted: 18 Dec 2013 08:00 AM PST

Those with prediabetes are not only in danger of developing diabetes, but also, at risk of dying early.

WE KNOW that people with diabetes are prone to serious, and sometimes, fatal complications.

As was said in my previous article (Sugar in the blood, Star2, Dec 5), prediabetes is just a condition where blood glucose (sugar) levels are higher than normal, but not as high as in people with untreated diabetes. So, we need not be worried about having prediabetes then, true?

Not true, unfortunately! Even though people with prediabetes have lower blood sugar levels than diabetics, they are also prone to developing complications that occur in people with (uncontrolled) diabetes; for example, kidney disease (nephropathy), eye disease (retinopathy) and nerve damage (neuropathy), especially to the legs.

But, diabetes-related complications are not the only conditions prediabetics need to be concerned about.

· Progression to frank diabetes

This is the most common consequence of prediabetes.

People with prediabetes are said to be about four to 10 times more likely to develop type 2 diabetes mellitus, compared to those without the condition.

Studies have also suggested that every year, about 10% of those with borderline high blood glucose levels – that is, one in every 10 prediabetics – will progress to become diabetics.

So, it follows that if you do not take steps to address your prediabetes, you could become a diabetic within 10 years!

The more overweight you are, and the higher your blood glucose levels are above normal, the more likely it is that you will develop diabetes.

It is also worth noting that type 2 diabetics almost invariably go through the prediabetic stage that lasts, on average, about 10 years before diabetes is diagnosed.

Clearly, there is plenty of time to improve our health and prevent the progression to diabetes!

Being diagnosed with prediabetes is a warning that your health is in danger, so start exercising and eating right to improve your wellbeing. ¿ Filepic

Being diagnosed with prediabetes is a warning that your health is in danger, so start exercising and eating right to improve your wellbeing. — Filepic

· Increased risk of heart disease and stroke

People with prediabetes are prone to developing cardiovascular disease (diseases of the heart and blood vessels), including suffering from heart attacks and stroke.

It is estimated that prediabetics are at least twice as likely to have a heart attack, compared to those with normal blood glucose levels.

And it would appear that having high blood glucose levels in the prediabetic range after meals is just as dangerous as for a diabetic, even when the fasting blood sugar level is still normal.

· Increased risk of dying from any cause

Studies have shown that the higher the blood glucose level, the higher is the risk of early death from any cause, including of course, stroke, heart attack, cancers and kidney failure.

The relationship is more obvious with sugar levels after food (measured by the oral glucose tolerance test, OGTT), as shown by landmark studies such as the DECODE (Diabetes Epidemiology Collaborative Analysis of Diagnostic Criteria in Europe) study involving more than 22,000 subjects.

Why the increased risk?

The exact cause of why people with prediabetes are more prone to heart disease or increased risk of dying (from any cause) is still not clear. Experts believe that the cause may be multifactorial, including the presence of:

· High blood pressure

People with diabetes (and prediabetes) are more prone to developing hypertension or high blood pressure (i.e. blood pressure 140/90 mmHg or higher).

If you have high blood pressure, your heart must work harder to pump blood around your body. Thus, uncontrolled high blood pressure will put a strain on your heart and damage your blood vessels, promoting fatty deposition.

By itself and in combination with other risk factors, high blood pressure increases your risk of cardiovascular disease (CVD), such as heart attack, stroke and kidney failure.

· Abnormal blood fat levels

In people with prediabetes, this is due to high levels of triglycerides (a type of fat), low levels of HDL ("good") cholesterol, and sometimes, high LDL ("bad") cholesterol, which may present singly or in combination.

Cholesterol can build up inside your blood vessels, especially when these are already damaged by intermittently-raised blood glucose levels (as may occur in people with prediabetes) and uncontrolled high blood pressure.

As a result, your arteries become hardened and narrow, restricting blood flow and increasing your risk for diseases of the heart and blood vessels (CVD).

· Overweight or obesity

If you are an Asian, you are deemed to be overweight if your body mass index (BMI) is between 23.0–24.9 kg/m², or obese if your BMI is 25.0 kg/m² or more.

Central obesity, i.e. having excess weight around your waist (as opposed to the hips), puts you at higher risk of heart disease because abdominal fat can increase production of LDL-cholesterol.

For Asians, a waist circumference of more than 90cm for men or more than 80cm for women means you have central obesity.

Overweight or obesity increases the risk for CVD.

In some studies, even mild to moderate overweight is associated with a substantial elevation in coronary artery disease risk, causing heart attack or heart failure.

· Metabolic syndrome

Raised blood glucose levels (such as in people with prediabetes), high blood pressure and abnormal blood fat levels (low HDL-cholesterol and/or high triglycerides) usually tend to be present together, especially in obese individuals (or those with central obesity).

According to the International Diabetes Federation, you are said to have metabolic syndrome if you have central obesity and two or more of the above conditions.

It is estimated that people with metabolic syndrome have a five-fold greater risk of developing type 2 diabetes, compared to those without.

And as expected, people with this syndrome – if not properly managed – are at higher risk of developing CVD, compared to those who have prediabetes alone.

They are three times as likely to have (and twice as likely to die from) a heart attack or stroke, compared with people without the syndrome.

These people are also more prone to kidney failure and early death.

From the above, it is clear that having prediabetes is not as innocuous as it seems.

Indeed, prediabetes puts one in danger of not only developing diabetes, but also heart disease, stroke, kidney failure and other serious complications, including early death.

So, it makes great sense for us to pay serious attention to our prediabetes, and to start taking good care of our health, so that we will not be burdened by its potentially serious (and sometimes fatal) complications.

In the next article on Jan 2, we will learn how to best look after ourselves if we have prediabetes.

Emeritus Professor Datuk Dr Mustaffa Embong is a consultant diabetologist and (honorary) executive chairman of the National Diabetes Institute (NADI) of Malaysia. This article is provided by NADI under the "Prevention of Diabetes and Heart Disease" Programme, which is fully funded by the Health Ministry's Health Promotion Board.


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