the red flag of prediabetes and when and how remission can be achieved

What does blood taste like? It is probably difficult for us to describe it and we respond based on childhood memories, those experiences with detached “shells” that adults told us we should not touch, scratch, much less lick. “Salada” will bring back our memory. Something metallic, the most detail-oriented will say. Not sweet. The blood should not have excess sugar.

However, more and more people and at increasingly younger ages develop diabetes or prediabetes, that is, they have high blood glucose (sugar) levels which, in the long term, causes Serious damage in the heart, blood vessels, eyes, kidneys and nerves.

This means that adults with diabetes are at risk 2 to 3 times higher risk of myocardial infarction and stroke. Neuropathy of the feet combined with reduced blood flow increases the risk of foot ulcers, infection and, ultimately, amputation. While diabetic retinopathy is a major cause of blindness. Diabetes is also among the main causes of kidney failure.

In Argentina, almost 13% of those over 20 years of age live with diabetes, which is equivalent to about 4 million peoplea prevalence that has been constantly increasing in recent decades, in line with the growth of overweight and obesity, which favor the advancement of diabetes mellitus or type 2, the most common.

“The most worrying thing is that 45% of people with diabetes do not know their diagnosis and that means that they cannot take any care initiative regarding their disease,” warned Carla Musso, vice president of the Argentine Diabetes Society (SAD).

But not only is the diagnosis of diabetes ignored. Also the impact of obesity is underestimated or minimized as predisposing factorhighlighted Martín Rodríguez, president of the SAD.

In Argentina, 6 out of 10 people are above their healthy weight. “Something striking, as we have seen in a study, is that 68% of people who are overweight or obese consider that their weight is normal or slightly elevated, that is there is no awareness of what obesity entails“.

Rodríguez stressed that obesity should not be “trivialized”: “It is a pathological condition, as well as a sedentary lifestyle. Moving is an inherent condition of being human and we have been losing it over the years.”

In this sense, he pointed out that 65% of people with obesity do not carry out the minimum recommended physical activity and pointed out that given the high prevalence of both factors (excess weight + sedentary lifestyle, added to some others), in Argentina, a third of the population, although I perceive itpresents a “high risk” of developing diabetes.

Following that, in a meeting with journalists in which he participated Clarion On the eve of World Diabetes Day – which is commemorated on November 14 – Musso and Rodríguez emphasized the importance of knowing the diagnosis (especially people at higher risk of developing it), in which the prediabetes It is also serious, in that you have to get out of the glucocentric view of diabetes and the key measures to prevent the disease. They also answered if remission is possible, in what instance and how it is achieved.

Diabetes does not show symptoms until it is in an advanced stage, when the damage is already very severe. Therefore, periodically evaluating blood glucose levels allows us to reach a early diagnosiswhich opens a greater margin to adopt care measures that prevent the progression of the disease and its consequences.

Screening is particularly important in those at high risk of developing diabetes: people with a first-degree family history (mother/father with diabetes); overweight, obese or sedentary; over 35 years of age with high blood pressure, low HDL cholesterol or who have some degree of depression; women who have had gestational diabetes or children born weighing more than 4 kilos.

“People who have one or more of these conditions should see their doctor for blood glucose testing or a blood glucose study,” Musso advised.

How is diabetes diagnosed? “The diagnosis is made when a person has two blood glucose levels greater than or equal to 126 mg/dl, that is, a blood test after 8 hours of fasting. Or else, by the oral glucose tolerance test, which gives a blood glucose greater than or equal to 200 mg/dl,” said the endocrinologist, coordinator of the Diabetes Service of the Favaloro Foundation.

And what happens to those who are on the limit? That do not reach diabetes values, but are on the border.

Those people with risk factors who present altered fasting blood glucose between 100 and 125 mg/dl or glucose tolerance values ​​between 140 to 199 mg/dlare considered to have prediabetes, “which is not a pre-disease, but a disease in itself,” Musso clarified.

The specialist explained that “the complications that were theoretically believed to appear at the time when diabetes was diagnosed, were seen to already appear in this situation of prediabetes, both macrovascular (such as cardiovascular disease and stroke), and microvascular (retinopathy, nephropathy)”.

“That’s why the idea is to be able act now in prediabetes. Acting means implementing habit changes in order to avoid progression. And if necessary, indicate medication, since there are drugs authorized for this stage as well,” said the vice president of the SAD.

“If we intervene in prediabetes – where there is already a risk – we can reduce the risk of diabetes. The most important thing is to act previously in the general population by attacking obesity and sedentary lifestyle as a State policy,” Rodríguez stressed.

To demonstrate the impact that these measures can have on the control of risk factors, he resorted to the results observed in a study by the National Diabetes Prevention Program of the United States: “Without making any intervention or making a minimal intervention, 10% of people with prediabetes went on to have diabetes in a year while carrying out a lifestyle intervention – which involves carrying out two and a half hours of physical activity per week and losing 7% to 10% of weight. reduced the risk of diabetes by 58%“.

Among the lifestyle modifications that are part of the non-pharmacological treatment of diabetes are summarized in six variables contained in the latest consensus of the American Association of Clinical Endocrinologists (AACE), shared by the SAD.

“Among other measures, we must increase the consumption of fruits and vegetables,” Rodríguez emphasized, and reduce the consumption of ultra-processed foods.

“Exercise is the true polypill for cardiovascular health,” said the president of the SAD.

“Some diabetes prevention programs established a minimum of 150 minutes per week, that is, two and a half hours of moderate intensity aerobic activity such as walk at 4 kilometers per hour“.

“Maybe it is not strictly necessary to go to the gym or go for an hour’s walk every day (which is very good), but it is necessary to periodically get up from the chair and walk two/three minutes, use the stairs,” the doctor stressed.

“They are fundamental scheduled physical activity and non-sedentary behavior. The mere fact of changing from being completely still to moving a little already changes the epidemiology, the risk of death, the curves begin to improve with minimal movement. Reaching 150 minutes/300 minutes per week is the most important goal, but stopping sitting still is already progress.”

“Nowadays people sleep little and this also affects the risk of suffering from diabetes, obesity and also predisposes them to poor control.”

“Although the number of people who smoke has decreased, it continues to be a scourge,” said the doctor.

“It has increased during the pandemic and is another condition that favors the development of diabetes, obesity and its poor control.”

“It is a common disorder in the population and even more common in people with diabetes,” highlighted the professional.

Another point that stands out from SAD is the importance of keeping not only blood glucose under control, as if diabetes were an isolated condition, but also cholesterol and blood pressure.

“We know that diabetes is not just about controlling glucose, we have to get away from this glucocentric view that we had a few years ago,” Musso stressed.

“Today we know that in people with diabetes we must control cholesterol, body weight, blood pressure and antiplatelet therapy if necessary (evaluate whether medication is needed to prevent the formation of blood clots); look at the patient as a whole“

“Cardiovascular risk factors should be evaluated systematically, at least once a year, as well as kidney disease markers (albuminuria is a very easy determination to make and provides a lot of information),” added the endocrinologist.

Current treatments accompany this tendency to move away from the glucocentric view. “Today we have new medications that help reduce the risk of cardiorenal disease and for the treatment of overweight and obesity. “We hope this will translate into lower complication rates in people with diabetes.”

Is it possible to cure diabetes? No. But remission does, say the specialists.

“Remission implies not having to take the medication anymore and achieving prediabetes levels or – ideally – normality, which is more difficult,” Rodríguez explained.

Why is it not healing? Because it is a reversible condition. “That person who managed to remit diabetes, if he gains weight again and stays still, the diabetes reappears.”

How is remission achieved? “With loss of around 10% of weight through changes in diet and physical activity. Nowadays bariatric surgery has also shown good progress, but it is limited to a very small percentage of the population, so remission “It’s through diet and exercise, there is no other solution for now.”

The referral does not occur at any stage of the disease. “It is in the earliest stages when this strategy is effective, but not when a patient with diabetes has already had the disease for many years,” said Rodríguez.

And he concluded: “Many people ask in the office when they are just diagnosed, can I not take medication? The answer is yes, but you have to make a nice effort and change habits“.

➪Check here the SAD activities open to the public for Diabetes Day.

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