Pre-diabetes: Are you at risk?

Hypertension, polycystic ovarian syndrome and high cholesterol can increase your risk of developing impaired glucose tolerance, which causes your blood sugar levels to rise above normal.

Most of us are aware of the risk factors, causes and consequences of Type 2 diabetes. But there's a related, yet less often talked about condition that affects a significant number of Singaporean women every year. It's called pre-diabetes.

Pre-diabetes is a condition in which a person's blood sugar levels are higher than normal but not high enough to be diagnosed as full-blown diabetes.

According to Dr Stanley Liew, specialist in endocrinology and consultant at Raffles Diabetes & Endocrine Centre, Raffles Hospital, pre-diabetes is usually without symptoms and can only be detected through a blood test.

Depending on the blood test used, the condition may be categorised as "impaired fasting glucose" (IFG) or "impaired glucose tolerance" (IGT).

Who is at risk?

The Ministry of Health's National Health Survey, which was last conducted in 2010, revealed that 14.4 per cent of people in Singapore between the ages of 18 and 69 had IGT.

The figure was higher in women (15.2 per cent) compared to men (13.5 per cent) and, unfortunately, those percentages are thought to be on the rise.

How do you know if you should be tested for pre-diabetes?

Dr Daniel Wai, an endocrinologist at Mount Elizabeth Hospital recommends you get screened if you are over the age of 40, if you have a family history of diabetes, if you're overweight or obese, if you were diagnosed with gestational diabetes or delivered a baby who weighed 4kg or more, if you have polycystic ovarian syndrome (this causes insulin resistance which puts you at risk of diabetes or of being pre-diabetic), or if you suffer from any one of these conditions: hypertension, high cholesterol, heart disease or sleep apnoea.

The world standard unit for measuring glucose in blood is mmol/l, which stands for millimoles/litre. A normal fasting glucose reading is 6.1 mmol/l or less. In a pre-diabetic person, that reading is between 6.1 and 6.9 mmol/l, and in a person with diabetes, that reading is 6.9 mmol/l or higher

Says Dr Wai: "If you are considered a 'high risk' person, that is, you have more than one of the risk factors for developing pre-diabetes, or if you already have a high fasting sugar level, then you'll be given an Oral Glucose Tolerance Test, which measures your body's ability to use glucose."

The test involves drinking a sweet drink containing 75g of sugar. You'll be required to fast the night before and not consume anything on the morning of your test. Your blood is drawn while you're fasting, and then you're given time to consume the drink. Your blood is drawn a second time, two hours after you've consumed the drink.

"After two hours, if your blood sugar level reads 7.8 mmol/l or less, then it's normal. If you're pre-diabetic, your reading will range between 7.8 and 11.0 mmol/l, and if you're diabetic, that reading will show up as 11.0 mmol/l or higher," explains Dr Wai. Even if the test reads normal, it should be repeated every three years if you're considered in the high-risk group.

If your fasting blood sugar level - the level that's read upon awakening after not having anything to eat or drink for eight hours - is elevated, your doctor may recommend an additional screening to diagnose which group of pre-diabetes you fall under - IFG or IGT, adds Dr Yong Lok Sze, a family physician at Lifescan Medical Centre, a subsidiary of Singapore Medical Group (SMG).

Why pre-diabetes is dangerous

Pre-diabetes may not be full-blown diabetes, but it's still a problem because it means that you're at a higher risk of developing diabetes and cardiovascular diseases like heart attack, stroke and peripheral vascular disease.

"Pre-diabetes can progress to diabetes if healthy lifestyle changes are not made," Dr Liew explains. "Without intervention, pre-diabetes is likely to become diabetes in 10 years or less. The progression to diabetes for patients with pre-diabetes is up to 10 per cent per year."

How to lower your risk

The good news is that you can lower your risk of pre-diabetes with just a few lifestyle changes. If you were recently diagnosed with pre-diabetes, these changes can also stop it from developing into full-blown diabetes.

One of the most effective lifestyle changes you can make is losing weight if you're overweight, and exercising more, says Dr Liew.

"The US Diabetes Prevention Program revealed that people with pre-diabetes can lower their risk of developing Type 2 diabetes by 58 per cent, by losing 7 per cent of their body weight and performing moderate exercise, such as brisk walking, 30 minutes a day, five days a week. "

Diet changes are also crucial. Says Dr Yong: "You should limit your intake of sugar, sweet treats like cake, candy, jam and honey, and unhealthy fat, such as the kind found in fried food, chips and pastries. At the same time, you should increase your intake of fibre, vegetables and fruit."

The Diabetic Plate is commonly prescribed to control pre-diabetes or diabetes, Dr Yong adds. This meal-planning approach involves filling half your plate with fruit and non-starchy vegetables, giving importance to how you prepare your vegetables (stir-frying, steaming, roasting and boiling are recommended).

Another quarter of the plate should contain whole-grains such as multi-grain bread, wholemeal bread/rolls or brown rice, and the final quarter of the plate should contain healthy proteins like fish, lean meat, poultry, seafood, eggs and/or low-fat dairy products.

You should aim for at least two servings of fish a week. If you are thirsty, choose water over sugary drinks like soda or sweetened tea and coffee.

Other recommended lifestyle changes include keeping your blood pressure and cholesterol levels under control, quitting smoking, and getting between seven and eight hours of sleep every night.

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