24 March 2011
“Researchers in Norfolk are beginning a £2m project to screen 10,000 people who are at high risk of type 2 diabetes. Some people whose blood sugar shows they are at a “pre-diabetes” stage will be assigned mentors – patients who already have the condition. The mentors will give other patients advice on diet and lifestyle – as well as getting support themselves from professionals.”
(BBC News Health 22.03.2011 viewed on www.bbc.co.uk/news/health)
This is exciting and extremely interesting news. Almost since we started, we at the Primary Care Training Centre have taken the condition of “Pre-diabetes” which used to be called “Impaired Glucose Tolerance” very seriously. This view was not always shared by other professionals partly because support in the literature was very limited.
Despite this, thinking professionals considered that Impaired Glucose Tolerance was equally as dangerous as type 2 diabetes in respect of cardiovascular disease. The situation was not helped by the fact that, because the patients did not have the big “D” label, they did not have access to all the screening procedures that people with diabetes did.
And yet, it was noted time and again what a high percentage of newly diagnosed people with diabetes already had one or more of the recognised complications of diabetes. We heard with interest rumours that some diabetologists were treating people with pre-diabetes with metformin.
In 2006, Canadian researchers showed that Rosiglitazone (now discontinued) prevented diabetes onset in people considered to be at high risk of developing the disease by 50% during a three year period (DREAM Study 2006). Further trial data is lacking to support this, but if the condition is caused by insulin resistance, surely it makes sense to try to reduce this at an early stage to prevent that first event.
It would seem very sensible that anyone with an HbA1C between 42-52 mmol/mol should be recorded as having pre-diabetes and managed with effective lifestyle advice. Medication is still a controversial issue and specialist advice might be necessary. They should be entered into the call/recall process of people with diabetes and monitored for any evidence of cardiovascular disease. Other risk factors such as dyslipidæmia and hypertension should be managed aggressively and a strong no smoking message given.
It has taken fifteen years for Impaired Glucose Tolerance to be given the respect it deserves. Well, better late than never; except for those patients with pre-diabetes who died of cardiovascular disease because their condition, although recognised, was not treated, even with lifestyle intervention strategies.
Find out more on our Diabetes Management training course.