Do I Have Prediabetes?

Based on the result of Basic Health Research (RISKESDAS), the prevalence of prediabetes in Indonesia is quite high, which is about 10.2%, so it is estimated that 24 million of Indonesian people suffer from prediabetes.

The term "prediabetes" refers to a condition in which the level of glucose, or blood sugar, is above normal but not high enough for a diagnosis of diabetes.

During the phase of prediabetes, there are three conditions the patients will likely experience. About one-third of them will remain with prediabetes, another one-third will develop type-2 diabetes mellitus (DMT2), and the blood glucose level of the other one-third of them can return to normal.

The risk of developing DM for prediabetes patients is increased about 2-10 times, in some conditions the risk may be higher. The risk of cardiovascular diseases (heart and blood vessels diseases) for those with prediabetes is equal to those with DM. Therefore, prevention of DM can be conducted through prediabetes treatment. Early identification and management of prediabetes will reduce DM occurrences and its complications, and benefit the patients, their families, and the government.

In the prediabetes condition, the body becomes resistant to insulin and unable to "cleanse" or take sugar from the bloodstream as it is supposed to. As the result, the blood sugar level becomes higher than the normal range. If this condition is prolonged, the patient will be at risk of developing diabetes. In addition, the risks of heart diseases and stroke will also increase.

Prediabetes condition includes impaired glucose tolerance (IGT) and/or impaired fasting glucose (IFG). The American Diabetes Association (ADA) defines prediabetes as IFG, where fasting glucose level is between 100 mg/dl (5.6 mmol/L) and 125 mg/dl (7.0 mmol/L) or IGT, where the blood glucose is between 140 and 199 mg/dl (7.8-11 mmol/L) 2 hours after the patient had 75 gram of glucose. WHO defines IGT similarly to ADA, and as for the IFG criteria, WHO' s minimum glucose level is 110 mg/dl (6.1 mmol/L).

Fasting glucose is defined as impaired (IFG) when: (1) Fasting glucose is between 100 and 125 mg/dl (5.6-6.9 mmol/L), and (2) Blood glucose 2 hours after having 75 g of glucose is less than 140 mg/dl. Whereas glucose tolerance is defined as impaired (IGT) when: (1) Fasting glucose is less than 100 mg/dl (below 5.6 mmol/L) and (2) Blood glucose 2 hours after having 75 g of glucose is between 140-199 mg/dl. Prediabetes occurs when there is IFG and/or IGT.

How to detect prediabetes?

Tests shall be performed to determine whether or not someone has prediabetes. The tests include the fasting blood sugar, conducted 2 hours after eating, and HbA1c tests.

- Fasting blood glucose

Blood sampling for this test is taken after 8-10 hours fasting. A fasting blood glucose level from 100-125 mg/dl indicates prediabetes because of the Impaired Fasting Glucose (IFG).

- Oral glucose tolerance test

Blood sampling for this test is taken 2 hours after the administration of 75 g glucose in 300 ml of water. A blood glucose level from 140 to 199 mg/dl indicates prediabetes because of the Impaired Glucose Tolerance (IGT).

- Hemoglobin A1c (HbA1c)

Blood sampling for this test can be done anytime. An A1c level between 5.7 and 6.4% indicates prediabetes.

Diabetes prevention is the only way to reduce its occurrence and complications. Lifestyle intervention (calorie intake restriction and moderate-intensity physical activity) for those with prediabetes is useful to prevent the development of diabetes and type 2 diabetes. This intervention is more beneficial compared to prevention by medication. Medication has several downsides such as high toxicity, low tolerability, high cost, and low efficiency.