Medical Dialogues
  • Dermatology
Login Register
This site is intended for healthcare professionals only
Login Register
  • MD Brand Connect
  • Vaccine Hub
  • MDTV
    • Breaking News
    • Medical News Today
    • Health News Today
    • Latest
    • Journal Club
    • Medico Legal Update
    • Latest Webinars
    • MD Shorts
    • Health Dialogues
  • Fact Check
  • Health Dialogues
Medical Dialogues
  • Medical News & Guidelines
      • Anesthesiology
      • Cardiology and CTVS
      • Critical Care
      • Dentistry
      • Dermatology
      • Diabetes and Endocrinology
      • ENT
      • Gastroenterology
      • Medicine
      • Nephrology
      • Neurology
      • Obstretics-Gynaecology
      • Oncology
      • Ophthalmology
      • Orthopaedics
      • Pediatrics-Neonatology
      • Psychiatry
      • Pulmonology
      • Radiology
      • Surgery
      • Urology
      • Laboratory Medicine
      • Diet
      • Nursing
      • Paramedical
      • Physiotherapy
  • Health news
      • Doctor News
      • Government Policies
      • Hospital & Diagnostics
      • International Health News
      • Medical Organization News
      • Medico Legal News
      • NBE News
      • NMC News
  • Fact Check
      • Bone Health Fact Check
      • Brain Health Fact Check
      • Cancer Related Fact Check
      • Child Care Fact Check
      • Dental and oral health fact check
      • Diabetes and metabolic health fact check
      • Diet and Nutrition Fact Check
      • Eye and ENT Care Fact Check
      • Fitness fact check
      • Gut health fact check
      • Heart health fact check
      • Kidney health fact check
      • Medical education fact check
      • Men's health fact check
      • Respiratory fact check
      • Skin and hair care fact check
      • Vaccine and Immunization fact check
      • Women's health fact check
  • AYUSH
    • Ayurveda
    • Homeopathy
    • Siddha
    • Unani
    • Yoga
  • State News
      • Andaman and Nicobar Islands
      • Andhra Pradesh
      • Arunachal Pradesh
      • Assam
      • Bihar
      • Chandigarh
      • Chattisgarh
      • Dadra and Nagar Haveli
      • Daman and Diu
      • Delhi
      • Goa
      • Gujarat
      • Haryana
      • Himachal Pradesh
      • Jammu & Kashmir
      • Jharkhand
      • Karnataka
      • Kerala
      • Ladakh
      • Lakshadweep
      • Madhya Pradesh
      • Maharashtra
      • Manipur
      • Meghalaya
      • Mizoram
      • Nagaland
      • Odisha
      • Puducherry
      • Punjab
      • Rajasthan
      • Sikkim
      • Tamil Nadu
      • Telangana
      • Tripura
      • Uttar Pradesh
      • Uttrakhand
      • West Bengal
  • Medical Education
      • Ayush Education News
      • Dentistry Education News
      • Medical Admission News
      • Medical Colleges News
      • Medical Courses News
      • Medical Universities News
      • Nursing education News
      • Paramedical Education News
      • Study Abroad
  • Industry
      • Health Investment News
      • Health Startup News
      • Medical Devices News
      • Pharma News
      • Pharmacy Education News
      • Industry Perspective
  • MDTV
      • Health Dialogues MDTV
      • Health News today MDTV
      • Latest Videos MDTV
      • Latest Webinars MDTV
      • MD shorts MDTV
      • Medical News Today MDTV
      • Medico Legal Update MDTV
      • Top Videos MDTV
      • Health Perspectives MDTV
      • Journal Club MDTV
      • Medical Dialogues Show
This site is intended for healthcare professionals only
LoginRegister
Medical Dialogues
LoginRegister
  • Home
  • Medical news & Guidelines
    • Anesthesiology
    • Cardiology and CTVS
    • Critical Care
    • Dentistry
    • Dermatology
    • Diabetes and Endocrinology
    • ENT
    • Gastroenterology
    • Medicine
    • Nephrology
    • Neurology
    • Obstretics-Gynaecology
    • Oncology
    • Ophthalmology
    • Orthopaedics
    • Pediatrics-Neonatology
    • Psychiatry
    • Pulmonology
    • Radiology
    • Surgery
    • Urology
    • Laboratory Medicine
    • Diet
    • Nursing
    • Paramedical
    • Physiotherapy
  • Health news
    • Doctor News
    • Government Policies
    • Hospital & Diagnostics
    • International Health News
    • Medical Organization News
    • Medico Legal News
    • NBE News
    • NMC News
  • Fact Check
    • Bone Health Fact Check
    • Brain Health Fact Check
    • Cancer Related Fact Check
    • Child Care Fact Check
    • Dental and oral health fact check
    • Diabetes and metabolic health fact check
    • Diet and Nutrition Fact Check
    • Eye and ENT Care Fact Check
    • Fitness fact check
    • Gut health fact check
    • Heart health fact check
    • Kidney health fact check
    • Medical education fact check
    • Men's health fact check
    • Respiratory fact check
    • Skin and hair care fact check
    • Vaccine and Immunization fact check
    • Women's health fact check
  • AYUSH
    • Ayurveda
      • Ayurveda Giuidelines
      • Ayurveda News
    • Homeopathy
      • Homeopathy Guidelines
      • Homeopathy News
    • Siddha
      • Siddha Guidelines
      • Siddha News
    • Unani
      • Unani Guidelines
      • Unani News
    • Yoga
      • Yoga Guidelines
      • Yoga News
  • State News
    • Andaman and Nicobar Islands
    • Andhra Pradesh
    • Arunachal Pradesh
    • Assam
    • Bihar
    • Chandigarh
    • Chattisgarh
    • Dadra and Nagar Haveli
    • Daman and Diu
    • Delhi
    • Goa
    • Gujarat
    • Haryana
    • Himachal Pradesh
    • Jammu & Kashmir
    • Jharkhand
    • Karnataka
    • Kerala
    • Ladakh
    • Lakshadweep
    • Madhya Pradesh
    • Maharashtra
    • Manipur
    • Meghalaya
    • Mizoram
    • Nagaland
    • Odisha
    • Puducherry
    • Punjab
    • Rajasthan
    • Sikkim
    • Tamil Nadu
    • Telangana
    • Tripura
    • Uttar Pradesh
    • Uttrakhand
    • West Bengal
  • Medical Education
    • Ayush Education News
    • Dentistry Education News
    • Medical Admission News
    • Medical Colleges News
    • Medical Courses News
    • Medical Universities News
    • Nursing education News
    • Paramedical Education News
    • Study Abroad
  • Industry
    • Health Investment News
    • Health Startup News
    • Medical Devices News
    • Pharma News
      • CDSCO (Central Drugs Standard Control Organisation) News
    • Pharmacy Education News
    • Industry Perspective
  • Home
  • Diabetes and Endocrinology
  • Diabetes and Endocrinology Perspective
  • Prediabetes Needs...

Prediabetes Needs Proactive Management In India: Why?

Written By : Dr Manoj Khandelwal Published On 2024-04-18T11:00:09+05:30  |  Updated On 19 April 2024 12:52 PM IST
Prediabetes Needs Proactive Management In India: Why?
  • facebook
  • twitter
  • linkedin
  • whatsapp
  • Telegram
  • Email

Prediabetes, also termed intermediate hyperglycemia or non-diabetic hyperglycemia, a high-risk state for developing diabetes, is defined by glycaemic variables that are higher than normal but lower than the thresholds for diabetes. It includes impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) (1). According to the American Diabetes Association (ADA), IFG 100-125 mg/dL (5.6 and 6.9 mmol/L) and HbA1c 5.7-6.4% (39 and 47 mmol/mol) are diagnostic of prediabetes. The World Health Organization (WHO) defines an IGT 140-199 mg/dL (7.8 and 11.0 mmol/L) and an IFG 110-125 mg/dL (6.1 and 6.9 mmol/L) as intermediate hyperglycemia (2).

Prediabetes Deserves More Attention: The prevalence of prediabetes is increasing worldwide (3). According to the ICMR-INDIAB-17 study, the prevalence of prediabetes in India is 15.3%, higher than the prevalence of diabetes (11.4%), which makes prediabetes a bigger problem than type 2 diabetes itself. The weighted prevalence of IFG (as per WHO cutoff) is much more than the IGT (10·1% vs 3·3%). IFG prevalence is significantly higher among females and IGT among males, but with similar trends in urban and rural areas (4).

Prediabetes Likely to Progress to Diabetes: The annual conversion rate of prediabetes to diabetes is 5%- 10% (3). About 19.4% of Indian normal glucose tolerance (NGT) patients developed diabetes, whereas 25.7% developed prediabetes, a total conversion rate to dysglycemia of 45.1%. Given these circumstances, a better awareness of prediabetes could benefit early identification and timely management, thereby lowering the development of diabetes and associated complications (2).

Indian Risk Factors for Prediabetes: Often, the risk of prediabetes increases with BMI. Obesity and hypertension increase the risk of prediabetes by 6.75% and 1.35%, respectively, in India (5). Other Indian risk factors for prediabetes include family history of diabetes and gestational diabetes mellitus, triglycerides (TG) level above 200 mg/dL, and high-density lipoprotein-cholesterol (HDL-C) level less than 35 mg/dL (2).

What Other Clinical Risks Ensue If Prediabetes is Not Treated?

Prediabetes increases the risk of all-cause mortality and the incidence of cardiovascular outcomes, coronary heart disease, stroke, chronic kidney disease, cancer, and dementia (6).

Prediabetes increases the risk of cardiovascular disease and all-cause mortality. A meta-analysis evaluating the association between prediabetes and the risk of all-cause mortality and incident cardiovascular disease indicated that in the general population, prediabetes was associated with an increased risk of all-cause mortality (relative risk/RR 1.13), composite cardiovascular disease (RR 1.15), coronary heart disease (RR 1.16), and stroke (RR 1.14) in a median follow-up time over 9.8 years. In patients with atherosclerotic cardiovascular disease, prediabetes increased the risk of all-cause mortality (RR 1.36), composite cardiovascular disease (RR 1.37), and coronary heart disease (RR 1.15) in a median follow-up time of 3.2 years. Therefore, timely screening and proper management of prediabetes might contribute to primary and secondary prevention of cardiovascular disease (1). Diabetic retinopathy is found to be present in about 6% of Asian Indians with prediabetes. It is further noted that higher HbA1c values among individuals with prediabetes doubled the risk for diabetic retinopathy (7).

Screening of Prediabetes:

American Diabetes Association Standard of Care-2024: The American Diabetes Association Standard of Care-2024 suggests that the testing for prediabetes should be done in adults with overweight or obese (BMI ≥25 kg/m2 or ≥23 kg/m2 in Asian American individuals) who have one or more risk factors, including first-degree relative with diabetes, history of cardiovascular disease, hypertension (≥130/80 mmHg or on therapy for hypertension), HDL cholesterol level <35 mg/dL (<0.9 mmol/L) and/or a triglyceride level >250 mg/dL (>2.8 mmol/L), individuals with polycystic ovary syndrome, physical inactivity, and other clinical conditions associated with insulin resistance (e.g., severe obesity, acanthosis nigricans) (8).

Indian Consensus on Prediabetes: The Indian Consensus Statement on Approach and Management of Prediabetes in India suggested using the Indian Diabetes Risk Score (IDRS) to screen prediabetes with clinical risk factors. The score predicts the probability of diabetes based on four simple parameters: age, abdominal obesity, family history of diabetes, and physical activity (2).

Latest International Diabetes Federation 2024 Position Statement: A new position statement from the International Diabetes Federation advises using 1-hour post-load plasma glucose (as defined by plasma glucose ≥ 155 mg/dL [8.6 mmol/L]) to improve the identification of people at risk for developing T2D, the risk for micro- and macrovascular complications and mortality, obstructive sleep apnoea, cystic fibrosis-related diabetes mellitus, metabolic dysfunction-associated steatotic liver disease and severity of hepatic fibrosis. The statement also noted that the 1-hour post-load plasma glucose also provides an opportunity for earlier detection and intervention in high-risk populations, benefits from lifestyle and pharmacologic interventions to reduce progression to T2D, and even reduces diagnostic complexity and confusion with current diagnostic criteria for intermedia hyperglycemia (9).

Pharmacotherapy as an Adjunct to Lifestyle Therapy: Lifestyle interventions can modify the progression of individuals towards overt diabetes, and it is known to reduce prediabetes by 58%. However, lifestyle interventions are centered around very intensive diet and adherence. Pharmacotherapy may be required and important in patients with severe hyperglycemia, individuals more susceptible to worsening dysglycemia, developing diabetes, developing CV complications, or having positive family history of diabetes (2).

Metformin in Prediabetes: Metformin is the pharmacological agent recommended for preventing or postponing T2D. The Indian Council of Medical Research (ICMR) and Research Society for the Study of Diabetes in India (RSSDI) recommend Metformin in prediabetes primarily for preventing T2D and delaying the onset of T2DM, secondary prevention of prediabetes, and primordial prevention of vascular ill health when metformin is given to prediabetes patients to prevent vascular complications (2).

The current ADA guidelines state that metformin should be considered in those with prediabetes, especially with BMI >35 kg/m2, age above 60 years, women with prior gestational diabetes mellitus, and individuals where lifestyle intervention is insufficiently effective in reducing body weight and improving glucose tolerance. The RSSDI guidelines recommend considering metformin at the dose of 500mg twice daily (2).

Metformin is Drug Controller General of India (DCGI) approved in the management of prediabetes for reducing the risk or delay of the onset of T2DM in adults, overweight patients with IGT, and/or IFG, and/or increased HbA1C who are at high risk for developing overt T2DM and still progressing towards T2DM despite implementing intensive lifestyle changes for 3 to 6 months (10).

Impact of Prediabetes Awareness Program: Prediabetes awareness and knowledge are significantly inadequate in India. A survey among Indian individuals with prediabetics showed that 90% had poor knowledge about prediabetes, which indicated that large-scale prediabetes screening and management programs are urgently needed. The survey also noted that implementing prediabetes education programs increased the self-management skills among people living with prediabetes. The study concluded that a prediabetes education program could significantly improve knowledge, attitude, and self-management practices among Indian people living with prediabetes and could be an effective strategy to prevent diabetes in this high-risk population (11).

ACT Against Prediabetes: Practice Pointers

  • Prediabetes, a precursor for diabetes, has a higher prevalence than diabetes (15.3% vs 11.4%) in India (2).
  • Obesity and hypertension are the two common risk factors for prediabetes (2).
  • Prediabetes increases the risk of cardiovascular disease, all-cause mortality, and diabetic retinopathy.
  • Early diagnosis and treatment of prediabetes aggressively with appropriate drugs, when indicated are the key for the management of prediabetes (2).
  • Metformin is approved by DCGI India and is also approved in the United Kingdom and European Union for the management of prediabetes (10).
  • Prediabetes education programs could significantly improve knowledge, attitude, and self-management practices among Indian people living with prediabetes (11).

References:

1. Cai X, Zhang Y, Li M, Wu JH, Mai L, Li J, Yang Y, Hu Y, Huang Y. Association between prediabetes and risk of all-cause mortality and cardiovascular disease: updated meta-analysis. BMJ. 2020 Jul 15;370:m2297. doi: 10.1136/bmj.m2297.

2. Das AK, Mohan V, Ramachandran A, Kalra S, Mithal A, Sahay R, Tiwaskar M, Das S, Baruah MP, Jacob J, Sheikh S, Kesavadav J. An Expert Group Consensus Statement on "Approach and Management of Prediabetes in India". J Assoc Physicians India. 2022 Dec;70(12):11-12. doi: 10.5005/japi-11001-0162.

3. Gong D, Chen X, Yang L, Zhang Y, Zhong Q, Liu J, Yan C, Cai Y, Yang W, Wang J. From normal population to prediabetes and diabetes: study of influencing factors and prediction models. Front Endocrinol (Lausanne). 2023 Oct 26;14:1225696. doi: 10.3389/fendo.2023.1225696.

4. Anjana RM, Unnikrishnan R, Deepa M, Pradeepa R, Tandon N, Das AK, Joshi S, Bajaj S, Jabbar PK, Das HK, Kumar A, Dhandhania VK, Bhansali A, Rao PV, Desai A, Kalra S, Gupta A, Lakshmy R, Madhu SV, Elangovan N, Chowdhury S, Venkatesan U, Subashini R, Kaur T, Dhaliwal RS, Mohan V; ICMR-INDIAB Collaborative Study Group. Metabolic non-communicable disease health report of India: the ICMR-INDIAB national cross-sectional study (ICMR-INDIAB-17). Lancet Diabetes Endocrinol. 2023 Jul;11(7):474-489. doi: 10.1016/S2213-8587(23)00119-5.

5. Chandrupatla SG, Khalid I, Muthuluri T, Dantala S, Tavares M. Diabetes and prediabetes prevalence among young and middle-aged adults in India, with an analysis of geographic differences: findings from the National Family Health Survey. Epidemiol Health. 2020;42:e2020065. doi: 10.4178/epih.e2020065.

6. Schlesinger S, Neuenschwander M, Barbaresko J, Lang A, Maalmi H, Rathmann W, Roden M, Herder C. Prediabetes and risk of mortality, diabetes-related complications, and comorbidities: umbrella review of meta-analyses of prospective studies. Diabetologia. 2022 Feb;65(2):275-285. doi: 10.1007/s00125-021-05592-3.

7. Rajalakshmi R, UmaSankari G, Sivaprasad S, Venkatesan U, Kumpatla S, Shanthirani CS, Viswanathan V, Mohan V. Prevalence and risk factors for diabetic retinopathy in prediabetes in Asian Indians. J Diabetes Complications. 2022 Mar;36(3):108131. doi: 10.1016/j.jdiacomp.2022.108131.

8. American Diabetes Association Professional Practice Committee; 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes—2024. Diabetes Care 1 January 2024; 47 (Supplement_1): S20–S42. https://doi.org/10.2337/dc24-S002

9. Bergman M, Manco M, Satman I, Chan J, Inês Schmidt M, Sesti G, Vanessa Fiorentino T, Abdul-Ghani M, Jagannathan R, Kumar Thyparambil Aravindakshan P, Gabriel R, Mohan V, Buysschaert M, Bennakhi A, Pascal Kengne A, Dorcely B, Nilsson PM, Tuomi T, Battelino T, Hussain A, Ceriello A, Tuomilehto J. International Diabetes Federation Position Statement on the 1-hour post-load plasma glucose for the diagnosis of intermediate hyperglycemia and type 2 diabetes. Diabetes Res Clin Pract. 2024 Mar;209:111589. doi: 10.1016/j.diabres.2024.111589.

10. Recommendations of the SEC (Endocrinology & Metabolism) made in its 86th meeting held on 26.04.2022 & 29.04.2022 at CDSCO (HQ), New Delhi. Retrieved on 3rd April 2024 from https://cdsco.gov.in/opencms/resources/UploadCDSCOWeb/2018/UploadCommitteeFiles/Recommendations%20Endocrinology%20%2026.4.22%20&%2029.4.22.pdf

11. Hyder KM, Mohan J, Varma V, Ponnusankar S, Raja D. Impact of prediabetes education program on Knowledge, attitude, and practice among prediabetic population of south India. Prev Med Rep. 2021 May 10;23:101395. doi: 10.1016/j.pmedr.2021.101395.

prediabetesdiabetesdr manoj khandelwaldiabetes managementprediabetes managementGlycometMetforminmetformin in prediabetes
Dr Manoj Khandelwal
Dr Manoj Khandelwal

    Dr Manoj Kumar Khandelwal did his M.B.B.S, MD (Medicine) from Mahatma Gandhi Medical College and Hospital, Jaipur and DNB in Endocrinology from Medanta - The Medicity, Gurgaon. He is currently associated with Fortis Escorts Hospital, Jaipur, as an Associate Consultant Endocrinology.

    Show Full Article
    Next Story

    Editorial

    Real-World Case study: Darbepoetin Alfa for Chemotherapy-Induced Anemia in Metastatic Breast Cancer - Dr Aditya Murali

    Real-World Case study: Darbepoetin Alfa for Chemotherapy-Induced Anemia in Metastatic Breast Cancer...

    Aspirin in Primary Prevention- When to Consider?

    Aspirin in Primary Prevention- When to Consider?

    Featured image representing medico legal

    What's the Role of Expert Opinion in Medical Negligence?

    7- Point Discharge Protocol for AECOPD: Time to Inculcate in Practice

    7- Point Discharge Protocol for AECOPD: Time to Inculcate in Practice

    Aspirin Use in Women Aged 40-50 with Diabetes and Hypertension: Identifying the Ideal Candidates

    Aspirin Use in Women Aged 40-50 with Diabetes and Hypertension: Identifying the Ideal Candidates

    View All

    Journal Club Today

    Real-World Case study: Darbepoetin Alfa for Chemotherapy-Induced Anemia in Metastatic Breast Cancer - Dr Aditya Murali

    Real-World Case study: Darbepoetin Alfa for Chemotherapy-Induced Anemia in Metastatic Breast Cancer...

    View All

    Health News Today

    Health Bulletin 09/ May/ 2025

    Health Bulletin 09/ May/ 2025

    View All
    © 2022 All Rights Reserved.
    Powered By: Hocalwire
    X
    We use cookies for analytics, advertising and to improve our site. You agree to our use of cookies by continuing to use our site. To know more, see our Cookie Policy and Cookie Settings.Ok