Not all pre-diabetics are the same

Chennai, August 2016
There is pre-diabetes and then, apparently, there is pre-diabetes. A recent study on published in Diabetes Care has indicated that innovation is required to treat a specific category of people with impaired fasting glucose, on whom regular interventions are not effective.

While arguing that systematic diabetes prevention in people with pre-diabetes could effectively reduce incidence by a third in the community, the paper goes on to state that people with impaired fasting glucose may require a different set of interventions. A collaboration between Emory University and the Madras Diabetes Research Foundation (MDRF), the D-CLIP paper is based on a study over three years of over 600 people with pre-diabetes in Chennai.

No large diabetes prevention trial has compared the effects of diabetes prevention strategies across the pre-diabetes spectrum, the paper claims. Ranjani Harish, of MDRF, and co-author said, “We are the first group to replicate the most successful U.S. Diabetes Prevention Programme, by culturally adapting their lesson plans to an Indian setting and used that model to study diabetes prevention.

Broadly speaking, the categories in the pre-diabetic stage are Impaired Fasting Glucose (IFG), Impaired Glucose Tolerance (IGT) and a combination of IFG and IGT.

Lifestyle modifications
The trial sought to measure the impact of a mix of lifestyle modifications, exercise and a dose of metformin, an anti-diabetes drug, (for those who failed to respond to lifestyle changes alone), among patients in preventing progression to diabetes.”

It was found that in the IFG group, people still moved to diabetes irrespective of the regimen they were put on.

Mary Beth Weber, of the Emory Global Diabetes Research Centre, Emory University, Atlanta, says, “Researchers in our group and elsewhere are still trying to understand why this is, but it might be due to the fact that some individuals develop a condition called beta cell dysfunction earlier than others. Beta cells are the cells in your pancreas that make insulin, the hormone that signals cells in your body that there is glucose — or sugar — in your blood. If the beta cells are not working well, they may not make enough insulin to clear the glucose from your blood stream. For these individuals, exercise and diet change may not be sufficient.”

Following a healthy diet, one that is rich in fresh fruits and vegetables and whole grains, low in sugar, and includes healthy fats; exercising at a moderate level for at least 150 minutes per week; and not smoking or using tobacco products are known to reduce diabetes risk.

In fact, R.M. Anjana of MDRF, says these changes did have a good preventive effect on the combined IFG and IGT group. The Hindu