Eight to nine out of ten prediabetics are unaware of their condition

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« Prediabetes and ‘preprediabetes’ are increasingly seen as a global public health problem, which policymakers should prioritize, » said Prof. Martin Buysschaert, UCL Emeritus Professor, former Head of the Department of endocrinology and nutrition at the Cliniques Universitaires Saint Luc.

Is prediabetes already a disease

Yes, it is the equivalent of a disease which a priori precedes, as its name suggests, true diabetes. Prediabetes is extremely common. It is estimated that 300 million people have prediabetes worldwide. If we consider that there are some 500,000 diabetics in Belgium, ie approximately 6% of the population, we can say that there are practically as many prediabetics. Eight or nine times out of ten, prediabetes goes unrecognized. This implies that in the presence of risk factors, it is important to detect this prediabetes.

How is prediabetes diagnosed?

It is essentially organic, and that is the problem. It is not a clinical diagnosis; the person does not have symptoms of diabetes. Currently, there are three diagnostic modes. The first is a measurement of fasting blood sugar. If it is between 100 and 126, we are already talking about abnormal fasting blood sugar, which is the equivalent of prediabetes. The second way is to make this diagnosis during a hyperglycemia test. This consists of drinking 75 g of glucose and then measuring blood sugar at different times. If at 120 minutes, it is between 140 and 200, we will speak of carbohydrate intolerance. Finally, the third diagnostic mode, recently validated, is the measurement of glycated hemoglobin, which has become a diagnostic tool when the value is between 5.7 and 6.5%. Although it is not useful to carry out these three tests, it may on the other hand be interesting to confirm an anomaly using another diagnostic mode.

What are the risk factors? In other words, who should get tested?

As soon as one is overweight (which leads to insulin resistance) with a body mass index greater than 25 and as soon as one has additional risk factors (e.g. family history of diabetes, history of gestational diabetes, arterial hypertension, physical inactivity, etc.), screening for prediabetes is indicated. These are indeed the recommendations of the American Diabetes Association, which advises to do this screening from the age of 45.

Why is it important to screen for prediabetes?

Because it is a situation where one evolves very naturally towards true diabetes. It is estimated that in about ten years, more than half of prediabetics have become diabetic. Next, screening is very important because prediabetes is already a major risk factor; it paves the way for cardiovascular complications. A prediabetic is in fact someone who, without knowing it, can develop a set of cardiovascular pathologies. In addition, prediabetes comes with other risks, including cancer, sleep apnea…

Does prevention therefore have all its meaning here?

Yes, especially since it is very effective. Prediabetes can indeed be perfectly treated with very simple measures. Studies show that the prescription in prediabetic people of lifestyle and dietary measures (diet and physical activity for 30 minutes a day) leading to a weight loss of around 5%, is extremely effective. Both in the sense of predicting diabetes, where the progression from prediabetic to diabetes is avoided, and in terms of a statistically significant reduction in the long term (20 years according to one study) in the risk of true diabetes , but also cardiovascular risk. This very positive message justifies a screening strategy by the attending physician, and the initiation of a lifestyle and dietary treatment. Measures which are also more effective than the first line drug (Metformin) against diabetes.

What would your message be?

Prediabetes is not irreversible. This is the stage where there is still a way to “turn back”, to heal before true diabetes appears. To cure is first to prevent.