The type 2 diabetes mellitus is the most common form of diabetes worldwide, accounting for about 90% of all cases. In Brazil alone, it is estimated that more than 7 million people are diabetic, and most of them do not know who is ill.
Unlike type 1 diabetes, which is genetic and usually arises in childhood, type 2 diabetes is not a disease that appears suddenly in healthy people. In general, it is a picture of slow installation, which mainly affects individuals with well-known risk factors such as family history, overweight, fat accumulation in the abdominal region, over the age of 45, etc.
Usually prior to developing type 2 diabetes, the patient goes through a stage called pre-diabetes, which is usually asymptomatic and can last for years. Although not be the actual disease diabetes mellitus, prediabetes can also cause damage to health such as an increased risk of developing cardiovascular disease.
In this article we explain what prediabetes. Let's talk about its causes, as its the diagnosis is made, what is the risk of progression to type 2 diabetes and what are the treatment options.
The pre-diabetes arises when the processing of glucose (sugar) in the body is not being done properly. Instead of serving as a source of energy for cells, the glucose remains circulating in the blood, causing its level is above normal (talk specifically the blood glucose values later on, in part over the pre-diabetes diagnosis).
Simply put, we can say that a person has pre-diabetes when their blood glucose (blood glucose level) is higher than normal but not yet high enough to be defined as diabetes.
To understand how the pre-diabetes arises, it is worth remembering how the body handles sugar ingested in the diet.
Most of the glucose present in our bodies comes from the food we eat, specifically of foods containing carbohydrates such as bread, pasta, rice, potatoes, pastries, fruit, corn, flour, cakes, etc.
During digestion, the sugar present in food is absorbed in the intestine and enters the bloodstream. As soon as the body detects an increase in the level of blood sugar, the pancreas starts to release a hormone called insulin. Insulin acts like a key that opens the doors of cells so that glucose can enter. Without insulin, glucose has no way to penetrate cells and without glucose, the cells can not function properly.
The entry of glucose into cells causes its concentration in the blood fall. The blood insulin level is controlled in a very accurate manner. If the blood glucose rises, the insulin level also rises; if the blood glucose falls, the release of insulin by the pancreas also reduces. Thus, the blood glucose concentration is always maintained within values considered suitable for the functioning of the body.
When the person have pre-diabetes, it is because the process described above is being carried out improperly. Usually, two mechanisms are responsible:
1. Pancreas can no longer produce adequate amounts of insulin, causing part of the glucose accumulates in the blood.
2. The cells become resistant to insulin action. The amount of insulin is adequate, but it is not effective in facilitating the entry of glucose into cells. This effect is especially common in overweight people, because excess fat is clearly associated with decreased insulin efficiency.
When the defect in one of the two mechanisms described above is mild, the patient develops pre-diabetes; when the defect is severe, the patient develops diabetes mellitus.
Laboratory methods for diagnosing pre-diabetes are the same as for diabetes diagnosis, which are only change the values.
1. Fasting glucose
The most widely used method for the diagnosis of both diabetes and prediabetes is called fasting glucose, which is the measurement of blood glucose level after a fast of at least 8 hours.
The normal is to have a fasting glucose of up to 99 mg / dl.
Individuals with a fasting glucose between 100 and 125 mg / dl on at least two different dosages are considered prediabetic.
Individuals with fasting glycemia equal to or above 126 mg / dl on at least two different dosages are considered diabetic.
To say that the patient has an impaired fasting glucose is another way of saying that he has pre-diabetes.
2. Haemoglobin Analyser (HbA1C)
The glycated hemoglobin is a test that measures the amount of glucose present in hemoglobin. The higher the blood glucose level over time, the greater is the amount of glycosylated hemoglobin. This test is very useful because he estimates the average blood glucose over the past three months. If the HbA1C comes high, it means that your blood glucose has been uncontrolled for the past three months at least.
The normal is to have a glycosylated hemoglobin below 5.7%.
Individuals with glycosylated hemoglobin between 5.7% and 6.4% are considered pre-diabetic.
Individuals with glycosylated hemoglobin above 6.5% are considered diabetic.
3. Pattern oral glucose tolerance (OGTT)
The oral glucose tolerance test is a test in which the patient dosage your fasting and again 2 hours after drinking a solution rich in sugar. This test is used to see how the body processes glucose soon after ingestion. Except in pregnant women, the OGTT is rarely used to diagnose pre-diabetes or diabetes.
It is normal to have an oral glucose tolerance test below 140 ml / dl.
Individuals with oral glucose tolerance test between 140 and 199 mg / dl are considered pre-diabetic.
Individuals with oral glucose tolerance test over 200 mg / dl are considered diabetic.
To say that the patient has glucose intolerance is another way of saying that he has pre-diabetes.
As the pre-diabetes is basically a stage before the onset of diabetes mellitus, the associated risk factors end up being about the same. The most important are:
Overweight (BMI greater than 25 kg / m²). The higher the BMI, the higher the risk.
Accumulation of abdominal fat (waist larger than 102 cm in men and greater than 88 cm in women).
Pre-diabetes is in basically two problems. The first is that it usually is associated with other risk factors for cardiovascular disease, especially overweight and high cholesterol. The second, which is the most important, is the fact that pre-diabetes is a stage just before the onset of diabetes, and this very common in the transition period of a few years.
If nothing is done, about 1/3 of patients with prediabetes will progress to diabetes within 3-5 years. If we consider only individuals with multiple risk factors, the progression rate is even higher.
The fact is that not everyone with prediabetes will necessarily progress to diabetes, but virtually all patients with type 2 diabetes at some point in life have gone through the pre-diabetes stage.
Therefore, as the risk of progression to type 2 diabetes is high and there is no way of knowing in advance that will progress or not, preventive measures should be instituted as soon as possible.
The pre-diabetes treatment is actually just a set of measures to prevent diabetes. The target is to attack risk factors that may be modified. Obviously, no one can do anything about the family history or the very old, however, much can be done about diet, smoking, a sedentary lifestyle and overweight.
All individuals with pre-diabetes should be directed to lose weight and achieve a BMI below 25 kg / m². But even small weight loss as little as 5% of body weight is enough to materially reduce the value of fasting glucose.
Another important factor is the regular practice of physical activity. Physical inactivity and excess fat decrease the effectiveness of insulin, while increasing muscle mass and regular exercise are the opposite effect, making the circulating insulin in the blood effectively. The important thing is not necessarily the intensity of exercise, but how often it is done during the week. The ideal is 30 minutes of activity 5 times a week to have significant effects, but even less often is even better than a sedentary lifestyle.
Who smokes should quit smoking immediately. Not only cigarette smoking is responsible for a long list of serious diseases, as it also increases the risk of diabetes by nearly 40%.
Drugs for prediabetes
In most cases there is no need to indicate drug treatment for the prevention of diabetes, since the food habits and life changes are usually sufficient to control blood glucose levels. Moreover, options that drugs actually slow the progression to diabetes without causing a range of unwanted side effect are very limited.
However, drug therapy may be useful in preventing type 2 diabetes in patients at high risk and who fail to implement the necessary lifestyle changes. Generally, drug use ends up being suitable for people under 60 years, BMI above 35 kg / m² or women with a history of gestational diabetes who can not or may not have a healthier lifestyle.
For these cases, the use of metformin, an oral antidiabetic can be indicated. Metformin helps reduce glucose levels and reduces the risk of progression to diabetes, especially in young obese people. It should be noted, however, that this drug is less effective than lifestyle changes, should therefore be restricted only to those who can not lose weight or exercising.
Orlistat (Xenical) is a drug that does not act directly on glucose, but as the patient helps you lose weight, just indirectly be useful in pre-diabetic control in overweight patients.
Addition of metformin and orlistat in selected cases, no other drug is usually indicated for the prevention of diabetes.
Bariatric surgery
Bariatric surgery is a more radical measure, which can indicated in patients with morbid obesity (BMI greater than 40 kg / m²) who can not lose weight otherwise. Patients undergoing this surgery lose weight quickly and show great improvement in their glucose metabolism.
