Senior endocrinologist Dr Pankaj Aggarwal tells The Sunday Guardian why the idea of prediabetes is getting popular and it is so important. Excerpts:

Q. What is prediabetes?

A. As the name suggests, it is the stage between normalcy and frank diabetes. Actually, the three entities are in a continuum. When blood glucose value starts rising above normal, initially it enters the zone of prediabetes and when it progresses further, it enters the zone of frank diabetes.

Q. Why is it gaining so much popularity? Is there any clinical significance of this entity?

A. Traffic light has three colours and the same is true for the spectrum of blood glucose levels as well. The green zone is normal wherein you are free to move; then comes yellow, which warns to be careful; and then it turns red, which orders you to stop, else you will be punished. Prediabetes is the intermediary warning zone before reaching the zone of actual harm or punishment.

Q. Does it mean that prediabetes itself is a harmless entity?

A. No, many population studies have proved that some complications of diabetes actually begin in the stage of prediabetes. It is particularly true for similar lifestyle disorders such as high blood pressure, high blood cholesterol and even heart attack or paralysis. Controlling blood glucose level and decreasing it from this zone to normal, can prevent development or progression of these dieters.

Q. What is normal blood glucose levels and their cut-offs for prediabetes and diabetes?

A. We derive glucose mainly from our food and so our blood glucose levels actually vary with intake of food. After an overnight fast, it is between 70 mg/dl and 100 mg/dl which increases to 100-140 mg/dl after 2 hours of having a meal. When blood glucose level rises beyond 126 mg/dl in fasting state and 200 mg/dl after 2 hours of meals, it is termed diabetes. Values between 100 mg/dl and 126 mg/dl (fasting) and 140 mg/dl and 200 mg/dl (after meals) are labelled prediabetes.

Q. Is it certain that a person who has become prediabetes will progress certainly to diabetes?

A. No, actually here lies the importance of detecting it at the level of prediabetes. It is the warning zone or ‘no man’s land’ between the borders of two countries. You can’t come back to your motherland easily after entering the neighbour’s territory but can still be brought back from the intermediate no man’s land. Prediabetes can be reversed.

Q. So what are the ways through which it can be reversed?

A. The two most common factors behind development of diabetes of adults or type 2 diabetes are, genetic predisposition and faulty lifestyle. The former is non-modifiable as we can’t choose our parents. But if one has a family history of diabetes, it should serve a warning signal that one should resort to adoption of a healthy lifestyle to prevent its progression into the state of diabetes. Correction of faulty lifestyle is actually the major route through which prediabetes can be reversed.

Q. Can you please detail upon the healthy lifestyle here?

A. Management of diabetes or prediabetes revolves around management of calories. If calorie intake is more than required, it accumulates in the body and predisposes a person towards development of diabetes, hypertension, high blood cholesterol and heart attack. Since fats in our diet are most calorigenic, it increases these probabilities to its maximum. So, reducing extra calories in diet in the form of paratha, poori, kachori, namkeen, samosa, pakoras, meat and sweets, remains the cornerstone of this management. Instead, one should have plenty of whole grain cereals (roti, daliya), dal, green leafy vegetables, fruits, low fat milk and milk products and white of egg. One should avoid frying or adding extra ghee or butter in the food to prevent weight gain. Regular exercises are most helpful in reducing the extra body fat if it has accumulated. These measures can help in reversing prediabetes.

Q. Do we have any medicine as well to help in reversing prediabetes?

A. Frankly speaking, medicines are meant for treating a disorder and not for preventing it. Though some anti-diabetic medicines like metformin, thiazolidinediones and acarbose have been tried to prevent the progression of prediabetes into diabetes but lifestyle interventions have been found to be most successful in this regard. 

Q. Has any study been tried to see whether reversal of prediabetes is possible or not?

A. A number of studies have been conducted so far wherein reversal of prediabetes and even diabetes has been studied. The Diabetes Prevention Programme, both global as well as national, is pioneer amongst all to show that this is possible and achievable.