2024-03-25 07:26:21
Elena Meli
The foundation for future cardiovascular health is laid early. Even more so if there are risk factors. At least 4 million people in Italy are pre-diabetes and just as many already diabetic. An epidemic
You don’t get type 2 diabetes overnight. We get there with a “long march” that begins many years before the diagnosis, without us realizing it; at a certain point, however, we may realize that we are on a bad path, because we enter a condition of pre-diabetes in which the blood sugar level is not yet too high but is above the warning level.
The condition
From here it would be possible to go back, with a little effort, and doing so could save your life, because when you have pre-diabetes there is a 60 percent greater chance of developing type 2 diabetes but above all the risk of cardiovascular events such as heart attacks and strokes, tumors, kidney or eye diseases is already higher than normal.
The people who should slow down the “march” towards a definitive debacle of sugar metabolism are many and often unsuspected: a recent US study has shown that among those with a “healthy” metabolism, according to standard definitions, one in five actually has the metabolism of a pre-diabetic, with blood sugar fluctuations that veer dangerously upwards during the day. This is what happens in people with diabetes, who have many glycemic peaks followed by significant drops in blood sugar: in those with pre-diabetes the peaks are only less acute, but the trend is identical.
He tests
The researchers noticed this thanks to continuous glycemic monitoring which allowed them to identify even the less obvious cases of pre-diabetes, but a simple test on fasting blood glucose is often enough to understand if we are on the wrong path, to be able to run for cover.
The numbers
An epidemic within an epidemic: alongside the four million Italians with diabetes and another million who have it without being aware of it, there are at least another four million fellow citizens with pre-diabetes. According to some estimates, according to which the problem affects at least one in three adults, there could be even more.
It is therefore better not to put your head in the sand, also because to know whether or not the sugar metabolism is out of balance, a simple blood sample is enough to measure the blood sugar level.
Values
Pre-diabetes occurs when the fasting blood sugar level is between 100 and 125 mg/dl or if the glycated hemoglobin, which is indicative of the blood sugar trend in the last two or three months, is between 5.7 and 6.4 percent ; the diagnosis also occurs if one undergoes a glucose “load curve”, drinking a solution of concentrated sugar, and after two hours the blood sugar level is still between 140 and 199 mg/dl (when everything is working as it should, the the action of insulin “sweeps” glucose away from the blood in a short time, allowing it to be stored in the cells). In all these cases, sugar metabolism is altered and the road to type 2 diabetes is paved. «Not only that, the probability of developing a tumor is also higher and the risk of having an early cardiovascular disease is approximately 20 percent higher», specifies Angelo Avogaro, president of the Italian Society of Diabetology (Sid).
The “red flags”
«Since the foundations for future cardiovascular health are already laid around the age of 30, 35, this is also the age at which it is appropriate to start checking blood sugar regularly, as recommended by the most recent guidelines from the American Diabetes Association— continues the specialist. Especially if there are “red flags” that increase the risk of diabetes, including for example being born underweight or overweight, to parents with diabetes, or having low “good” HDL cholesterol and high triglycerides, or even having a large waistline ( higher than 88 centimeters in women, 102 in men, ed.), indicative of the presence of a dangerous accumulation of abdominal fat”.
What you risk: 14 years less life
Pre-diabetes is bad, almost as bad as type 2 diabetes of which it is the precursor. And since it accelerates the onset of diabetes, it can also shorten life expectancy: according to a survey published in The Lancet Diabetes & Endocrinology at the end of the year, juvenile pre-diabetes and a diagnosis of type 2 diabetes by the age of 30 years reduce life expectancy by as much as 14 years. According to this analysis, conducted on over one and a half million people in 19 high-income countries, if you manage to postpone the onset of the disease until around the age of 40, you live on average “only” 10 years less, if the diagnosis arrives at 50 the “cut” is reduced to 6 years; on average, the negative effect on life expectancy is greater in females. «The younger you are when you develop type 2 diabetes, the greater the number
the damages. Recognizing glycemic abnormalities early and intervening to modify them can, however, prevent the long-term complications of diabetes”, conclude the authors.
Who should control themselves
«Even those who are sedentary, overweight or obese, or hypertensive patients or those being treated with drugs for high blood pressure are at risk of pre-diabetes and should control their blood sugar levels, certainly starting no later than the age of 45, if they have not started to do it sooner”, adds Riccardo Candido, president of the Association of Diabetologists (AMD). «Those who have already had cardiovascular diseases and all those who have first-degree relatives with type 2 diabetes should also check themselves without delay; Women who have suffered from diabetes during pregnancy or who have given birth to a baby weighing more than four kilos are also at greater risk of developing pre-diabetes. Although there are no obvious gender differences for pre-diabetes, women must pay particular attention because gestational diabetes is a highly dangerous element and because they are overweight more often than men.”
The subtypes
The heterogeneity of risk factors is probably one of the reasons why not all pre-diabetes are the same, at least according to research by the Institute for Research on Diabetes and Metabolic Diseases in Tübingen, Germany, published in Nature Medicine : experts have identified six different types, also different in terms of outcomes.
So for example, those who are obese, have abundant liver fat, tissues resistant to the action of insulin and poor insulin production are part of subtype 5, with a very high and immediate risk of developing diabetes; subtype 3 has a similar risk, in which there is an increase in blood sugar associated with high insulin production and above all with a clear genetic predisposition. Subtype 6, in which there is a little less liver fat and more insulin is produced, has a more moderate chance of progressing to diabetes, but a high risk of developing kidney and cardiovascular problems. However, there are those who, like people of subtype 4, are overweight or obese but with fat distributed mainly in the subcutaneous tissue and without a significant deterioration in blood sugar: in these cases the probability of progression towards diabetes is lower, as in subgroups 1 and 2 in which overweight is slightly lower and blood sugar levels are less elevated, although above the threshold for the diagnosis of pre-diabetes.
The differences
«The big difference is in the presence or absence of insulin resistance, typical of those who are overweight or obese, or in the reduction of the hormone’s production», comments Candido. «However, if it is useful for research to understand the mechanisms underlying pre-diabetes, on a clinical and practical level it is best to continue to consider them all equally high risk and intervene by changing lifestyle». «If anything, it may be useful to check whether the pre-diabetes is isolated or there is a metabolic syndrome and therefore high triglycerides», adds Avogaro, «because in this case for example it is more appropriate than ever to reduce dairy products and fruit, given that the fructose (also as a sweetener, ed.) enters the cells without the need for insulin mediation and stimulates the hepatic production of triglycerides.”
The role of abdominal fat
Diet is essential to combat pre-diabetes, also because it is one of the cornerstones for reducing abdominal fat which “strangles” the internal organs and is particularly harmful to the metabolism. It is no coincidence that recently a study published in The Lancet Diabetes & Endocrinology demonstrated that blood sugar can return to normal, and pre-diabetes regress, by losing 5 percent of one’s weight over the course of a year but above all at the level of waistline: those who lose weight elsewhere, perhaps by the same number of kilos, do not obtain the same positive results because tissue resistance to insulin remains high.
Eliminating visceral fat, according to the results, means “curing” pre-diabetes and stopping the march towards diabetes, so much so that the risk of getting ill is reduced by 73 percent. Weight management is essential and must involve, in addition to nutrition, an increase in physical exercise because as Avogaro specifies «Even the most virtuous or most rigid diet does not allow you to obtain really good results, if it is not associated with a adequate motor activity. Which, moreover, also helps to indulge in a few more calories at the table.”
Minimal exercise
30, 40 minutes of walking at least five days a week is the minimum; for many, reaching the goal remains difficult because, as Candido admits «the environment in which we live does not help to follow healthy lifestyles and a strong motivation is needed to stay active and not follow wrong dietary models: active policies would be needed to subvert the paradigm , from greater education at school, from early childhood, to interventions to make it more “complicated” to make wrong choices, a bit like what happened with the anti-smoking law which was the first, truly responsible for the reduction in the number of smokers”.
Drugs
There is no escape from a virtuous change in habits, but are there drugs that can be used to help in the task of “blocking” pre-diabetes? «To date, no drug is approved for the treatment of pre-diabetes», replies Candido. «However, in numerous scientific studies active ingredients such as metformin, acarbose, pioglitazone have given good results, therefore in selected cases the doctor can decide to prescribe them», concludes the president of the National Association of Diabetologists.
March 23, 2024 (changed March 23, 2024 | 8:30 pm)
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