You Ask , They Answer
Q
: What is prediabetes ?
A
: Prediabetes happens when a patient ’ s blood sugar level is higher than it should be but still not high enough for type 2 diabetes to be diagnosed . When patients have prediabetes , they will have impaired fasting glucose or impaired glucose tolerance .
Before somebody goes to type 2 diabetes and starts to show symptoms of diabetes , they will go through this prediabetic stage .
We don ’ t have any definitive data on trends or prevalence in Malaysia because it ’ s not currently collected , but the World Health Organization says that 5-10 percent of individuals with prediabetes will go on to have full diabetes within a year . This is why we ’ re very concerned about being able to identify patients with prediabetes before their disease progresses .
Q
: Why is it so important to know that you have prediabetes ?
A
: Once you know you have prediabetes , at least you can control or modify your risk factors to prevent the condition developing to full diabetes . Even the prediabetes stage is still associated with higher risk factors for cardiovascular disease , diabetic retinopathy ( damage to the retina ), or other diabetic complications . We want to reduce the risk of these complications . Many patients are not aware that they have prediabetes until they develop type 2 diabetes , and then they ’ re surprised with the diagnosis . That ’ s why it ’ s so important to have diabetes screening , particularly when you have risk factors such as obesity or high blood sugar .
Q
: Is diabetes more of a concern for older patients ?
A
: As our body ages , the risk of getting type 2 diabetes increases . Indeed , about 25 percent of adults over 65 with prediabetes will go on to have type 2 diabetes . At a younger age , patients with prediabetes are able to prevent complications , such as cardiovascular disease , because they ’ re more able to make lifestyle modifications ; however , they may be less motivated to make the necessary changes immediately . Some younger patients think they can wait until later to modify their lifestyle . Older patients are more likely to have better awareness of their health as they age , so they ’ re often more motivated to make such changes . Regardless of age , our goal is to delay the patient getting type 2 diabetes through our care .
Q
: Do older patients with prediabetes have to take extra measures ?
A
: No matter if you ’ re a younger patient or an older one , your approach to controlling diabetes will be the same .
C
Diabetes screening and lifestyle modification will always be the first-line treatment for prediabetes patients M . Lifestyle
modification is the most important thing . Some doctors will
Y start with medication to help control the prediabetes stage ,
CM and then some follow-up will be needed with our doctors ,
MY
dietitian , and diabetes nurse in order to support them . The medication they ’ re given depends on the patient CY ’ s individual condition .
CMY
Because lifestyle modification is so important , we will
K help patients manage their prediabetes through food choices because we understand that it ’ s difficult to change eating habits and make wiser choices . And then we ’ ll encourage them to choose low-fat , low-calorie , and high-fibre foods and advise them on how to take more exercise .
Q
: What can older patients do if they ’ re unable to exercise ?
A
: We will assess the patient to see if they ’ re able to do physical activity . If they can ’ t , we can suggest nonweight-bearing exercises like stationary cycling at home or swimming , which is particularly good because it doesn ’ t put stress on the joints . On top of that , we can refer patients to physiotherapists and sport specialists to develop exercise programmes suitable for them .
Dr Choong Shiau Yin
Choong Shiau Yin is a diabetes educator at IJN Diabetes Lifestyle Clinic in Kuala Lumpur .
10 AUGUST 2021 GlobalHealthAsiaPacific . com