emeritus prof datuk dr mustaffa embong
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| Watch out: Being overweight and obese (especially having excess fat around your waist) is strongly associated with the development of type 2 diabetes. – AFP |
ZAINAL is a 32-year-old accountant. He feels well though he has put on some weight lately. He attributes this to good food, especially after getting married.
Wong is 24 and has just started work as a teacher. She has been on the chubby side since young, but has not managed to shed the extra kilos. Her mother was diagnosed with diabetes at age 45.
Selva, a trader, is admitted to hospital for a heart attack. He is 45 years old and has high blood pressure and high cholesterol. His weight is normal (though he has a bit of tummy, which he says is due to the beer) and doesn’t believe he has diabetes.
These three people – of different ages, sex and ethnicity – have one thing in common: they have prediabetes. And they are not alone. It is estimated that more than 300 million people worldwide have the condition. In Malaysia, about 20% of the adult population suffer from prediabetes.
Prediabetes is a condition where your blood glucose (sugar) levels are higher than normal, but not high enough to be labelled as (type 2) diabetes.
Experts believe that, similar to type 2 diabetes, prediabetes is influenced by both genetic and environmental factors.
Researchers have determined that people with certain genetic make-ups are more prone to developing diabetes. The genetic abnormality tends to occur in families. Thus, if your close relative (mother, father, brother or sister) has type 2 diabetes, then you are also likely to develop prediabetes, which may progress to diabetes.
Being overweight and obese (especially having excess fat around your waist) are strongly associated with the development of type 2 diabetes. While the tendency to put on weight may have a genetic basis, a major reason is due to the excess calories from food intake.
It makes sense that people who overeat (leading to excess weight) and/or those who are not physically active are at high risk of developing prediabetes.
There are also other situations that increase one’s risk of developing prediabetes. These include having high blood pressure or abnormal blood fat levels (as in the case of Selva) or having been diagnosed with diabetes during pregnancy (gestational diabetes). Recent studies have also suggested that prediabetes is more likely to occur in people who do not have adequate sleep, as well as those who smoke.
Risk factors for prediabetes (and type 2 diabetes)
> Positive family history of type 2 diabetes.
> Being overweight/obese (BMI above 25) or having excess fat around the abdomen (measured as a waist circumference of greater than 90cm for men or greater than 80cm for women.
> Not physically active at work, or seldom exercise.
> Having high blood pressure (greater than 140/90 mmHg).
> Having abnormal blood fats levels (i.e. HDL cholesterol less than 1.0 mmol/L in a man or less than 1.3 mmol/L in a woman or triglyceride (TG) level above 1.7 mmol/L).
> Diagnosed with diabetes during pregnancy (gestational diabetes) or delivered a large baby (more than 4.0kg) in previous pregnancy.
> Diagnosed with polycystic ovary syndrome.
> Aged 30 years or older.
> Inadequate sleep (less than 5.5 hours a night).
There are two major physiological reasons people develop type 2 diabetes: impaired release of insulin by the pancreas and the inability of insulin to work properly in body cells (especially in your muscles, liver and fat tissues), referred to as “insulin resistance”.
As prediabetes is the precursor to type 2 diabetes, it is believed that the two factors are also operational in the prediabetes state.
Most of the sugar (glucose) in your body comes from the foods you eat, specifically foods that contain carbohydrates. During digestion, sugar enters your bloodstream and is absorbed into the body cells for use as energy or stored.
This process is enhanced by the presence of insulin, a hormone produced by the pancreas in response to a meal.
In people with prediabetes (as in those with type 2 diabetes), it is believed that the pancreas is not producing enough insulin, and at the same time, the body cells are less sensitive to its action. Because of this, glucose is not able to properly enter the cells and accumulates in your bloodstream, causing your blood sugar level to rise above normal.
Prediabetes is dangerous because people with prediabetes are more prone to many serious conditions, including progression to type 2 diabetes, heart disease, stroke and other serious conditions including kidney failure and risk of (early) death.
Usually, a person with prediabetes feels well (like Zainal) and does not have any symptoms pertaining to the condition. Most sufferers of prediabetes often do not know that they have the condition until type 2 diabetes has developed, or complications occur.
Zainal knew of his prediabetes when he went for a routine annual check-up while Wong discovered it during her medical examination for her job. Selva, however was told of the diagnosis after blood tests were done when he was admitted for a heart attack.
Overweight and obesity are closely associated with type 2 diabetes – and also with prediabetes. Both Zainal and Wong are likely candidates because of their weight. Selva, even though not overweight, is at risk because of the excess fat around his tummy – a condition referred to as abdominal obesity.
This condition is most common amongst Asians, which makes them more prone to prediabetes and type 2 diabetes (and heart disease as well) even though they are generally not fat or obese.
You should go for a blood glucose screening if you have any risk factor for diabetes, especially if you have a positive family history or you are overweight or obese, or lead a sedentary lifestyle.
When you should check if you have prediabetes and how the condition is diagnosed will be discussed in another article.
> Emeritus Professor Datuk Dr Mustaffa Embong is a consultant diabetologist and (honorary) executive chairman of the National Diabetes Institute (NADI) of Malaysia. The article is provided by NADI under the “Prevention of Diabetes and Heart Disease” programme, which is fully funded by the Health Promotion Board (HPB) of the Ministry of Health.
http://www.thestar.com.my/Lifestyle/Health/2013/11/14/What-is-prediabetes.aspx
