Addressing prediabetes …precursor to Type 2 Diabetes Mellitus

The website of the Centres for Disease Control and Prevention (CDC) has a very interesting initial statement on prediabetes, “It’s real. It is common. And most importantly, it’s reversible. You can prevent or delay prediabetes from turning into type 2 diabetes with simple, proven lifestyle changes”. Prediabetes is also sometimes called borderline diabetes. Prediabetes is often described as the “gray area” between normal blood sugar and diabetic levels. More than 8 in 10 of people with prediabetes do not know they have it. Prediabetes is a serious health condition. People with prediabetes have higher blood sugar than normal, but not high enough yet for a diabetes diagnosis. Prediabetes puts you at increased risk of developing type 2 diabetes, heart disease, and stroke.

People with prediabetes have up to a 50% chance of developing diabetes over the next five to 10 years. You can have prediabetes for years without symptoms. This means you are not likely to know whether you have prediabetes until serious health problems show up. Some people with prediabetes may experience darkened skin in the armpit or back and sides of the neck, called acanthosis nigricans, skin tags, small skin growths, eye changes that can lead to diabetes-related retinopathy.

Prediabetes is the precursor for diabetes mellitus, and therefore the pathophysiology is relatable. Hyperglycaemia (high blood glucose) will cause production and release of insulin by the pancreatic beta cells. Excess insulin exposure for long periods of time diminishes the response of the insulin receptors, the function of which is to open glucose channels leading to entry of glucose into the cells. Decreased function of the insulin receptors leads to further hyperglycaemia, further perpetuating the metabolic disturbance and leading to the development of not only type 2 diabetes but also metabolic syndrome.

In prediabetes, this process is not to the extent of diabetes mellitus but is a first step in a metabolic cascade, which has potentially dangerous consequences if not adequately addressed early. Prediabetes can have adverse effects on large and small blood vessels (e.g. arteries of the cardiovascular system or retina, kidney, and nerves).

Talk to your healthcare provider about getting your blood sugar tested if you have any of the risk factors for prediabetes. These prediabetes checks are essential because prediabetes often has no symptoms. You can have it for years and not know it. You may be at higher risk of prediabetes due to: Age (being 45 or older); Parent or sibling with Type 2 diabetes; Ethnicity: Being Black, Hispanic, Native American, Asian-American race or a Pacific Islander. Previous gestational diabetes; polycystic ovary syndrome; Certain medications (e.g. steroids, some antipsychotics); Hormonal conditions, including Cushing’s syndrome and acromegaly; Sleep disorders, such as sleep apnoea; physical inactivity; overweight/obesity; hypertension; high blood cholesterol levels; metabolic syndrome (a combination of high blood pressure, high cholesterol level and large waist measurement); smoking.

To test for prediabetes, your healthcare provider will use a blood test. You may have: fasting blood glucose test, which tests your blood after you have fasted for eight hours (had nothing to eat or drink except water); Glucose tolerance test measures blood sugar before and after drinking a glucose liquid. HBA1c test which provides your average blood glucose level over the past two to three months.

You would be diagnosed with prediabetes if: your fasting plasma glucose test 1 5.6mmol/L-6.9mmol/L (normal is <5.6mmol/L; diabetes is 7.0mmol/L); Glucose tolerance test measures blood sugar before and after drinking a glucose liquid. A result of 7.8mmol/L-11mmol/L indicates prediabetes; your HBA1c test is 5.7% to 6.4% (normal is < 5.7%); diabetes is 6.5% or higher).

Prediabetes may be referred to as impaired fasting glucose (IFT) if you have higher than normal sugar levels after a period of fasting, or as impaired glucose tolerance (IGT) if you have higher than normal sugar levels following eating.

The best way to treat prediabetes is through healthy lifestyle changes. Eating a nutritious diet and getting regular exercise can help prevent or delay Type 2 diabetes. Even small changes can significantly lower your risk for developing Type 2 diabetes. The Centres for Disease Control and Prevention recommends: Weight loss: Losing 5% to 7% of your body weight can have an impact. For example, a 100kg- person who loses 5-7 kg could see a significant health improvement. Regular activity: Aim for 30 minutes a day, five days a week, for a total of 150 minutes a week. Try walking or another activity you enjoy. Lowering your risk factors for prediabetes can often get your blood sugar levels back to healthy level.

Evidence abounds about the significant function of dietary polyphenols in the prevention and management of type 2 diabetes through the insulin dependent approaches: protection of pancreatic islet β-cell; reduction of β-cell apoptosis; promotion of ß-cell proliferation; attenuation of oxidative stress; activation of insulin signalling; stimulation of pancreas to secrete insulin and the insulin independent approaches including inhibition of glucose absorption, regulation of intestinal microbiota, modification of inflammation response, and inhibition of the formation of advanced glycation end products. Dietary polyphenols also reduce diabetic complications, such as vascular dysfunction, nephropathy, retinopathy, neuropathy, cardiomyopathy, coronary diseases and renal failure. Sun et al. Dietary polyphenols as antidiabetic agents: Advances and opportunities. Food Frontiers. 26 March 2020. https://doi.org/10.1002/ fft2.15). Cocoa is an excellent source of polyphenols.

It is estimated that more than 6.7 million people died from diabetes-related causes in 2021.Middle and low-income countries are seeing the biggest increases. Almost 540 million people already live with diabetes and by 2045, it is estimated over 780 million people will have the condition. The regular intake of polyphenol-rich cocoa by all should be seen as important step in preventing type 2 diabetes.

Author: Dr Edward Amporful, Chief CharmacistPharmacist, Cocoa Clinic