Pre-diabetes is referred to as blood glucose concentrations higher than normal, but lower than established thresholds for diabetes. It is widely recognized as a strong risk factor to diabetes development and cardiovascular disease. While the prevalence of diabetes is expected to increase world-widely in the near future, research shows that the prevalence of pre-diabetes will increase even more exponentially, owing to population exposure to different environmental factors that lead to insulin resistance such as sedentary lifestyle, high fat/caloric dietary consumption and obesity; thus entertaining the increasing prevalence of diabetes. Furthermore, pathophysiological mechanisms of pre-diabetes, which include insulin resistance and beta-cell dysfunction, have been linked with abnormalities of multiple organ functions such as nephropathy, retinopathy, neuropathy as well as macrovascular disease. Indeed, this may partly explains why certain people with diabetes type 2 present with overt diabetic complications at the time of their diabetes diagnosis.

Although there is no worldwide consensus on defining pre-diabetes, the current diagnostic criteria of pre-diabetes namely the Impaired Fasting Glucose (IFG), Impaired Glucose Tolerance (IGT), and glycated hemoglobin levels (HbA1c) may serve to formerly make a cut-off between the normal and the abnormal blood glucose concentrations. Certainly, optimizing pre-diabetes management would lead to reduced incidences of overt diabetes and associated cardiovascular disease, and limit the overwhelming costs associated with diabetes and its complications.
Research evidence has shown that lifestyle modification programs including diet modification, regular physical exercise and weight loss can treat pre-diabetes effectively. Indeed, lifestyle modification bears a relative risk reduction of 40–70% with respect to preventing development of diabetes. On the other hand, use of medical treatment such as metformin is beneficial particularly among people who cannot respond to/sustain adequate lifestyle measures. While efforts to recognize and manage pre-diabetes as a risk for diabetes are undertaken in resource rich settings, it is not the case in many resource limited settings where pre-diabetes is often unrecognized or even not considered as a disease entity. Also in such settings, standardized patient education models that can be used to address patients’ needs in knowledge are quasi-inexistent. Effective diabetic preventive measures will consist in early recognition of and management of pre-diabetic states, and in equipping the population with adequate knowledge; particularly because the latter will always be in the center of their own care

What are the clinical implications of pre-diabetes in your working area? How do you address the challenges of diagnosis and management of pre-diabetes particularly among people at risk?

Information about the discussion leader

The discussion will be moderated by Dr. Etienne AMENDEZO, Consultant Physician at King Faisal Hospital, Rwanda and Lecturer (Hons) at College of Medicine and Health Sciences - University of Rwanda.

References
1. ADA, What is Prediabetes? Clinical Diabetes 2013 Apr; 31(2): 95-95.
2. Rhee SY, Woo J-T. The prediabetic period: review of clinical aspects. Diabetes Metab J. 2011;35(2):107–16
3. Tabák AG, Herder C, Rathmann W, Brunner EJ, Kivimäki M. Prediabetes: a high-risk state for diabetes development. The Lancet. 2012;379(9833):2279–90.
4. Gillett M, Royle P, Snaith A, Scotland G, Poobalan A, Imamura M, et al. Non-pharmacological interventions to reduce the risk of diabetes in people with impaired glucose regulation: a systematic review and economic evaluation. Health Technol Assess. 2012 [cited 2016 Aug 9];16(33)