DIABETES MELLITUS

COMPLICATIONS
AND
PREVENTION
Dr.Rashmi Gupta Bajpai
Senior Consultant Internal Medicine
Venkateshwar Hospital
 Pre-diabetes

• Pre-diabetes represents an elevation of plasma glucose above the

normal range but below that of clinical diabetes
• A leading risk factor for type 2 diabetes
• Pre-diabetes can be identified as either Impaired Fasting Glucose (IFG)
or Impaired Glucose Tolerance (IGT)
• Pre-diabetes moreover aggregates commonly with other
Cardiovascular Disease (CVD) risk factors that make up the metabolic
syndrome

Grundy SM. Pre-Diabetes, Metabolic Syndrome, and Cardiovascular Risk. Journal of the American College of Cardiology. 2012;59(7):635–643.
 Prevalence

Worldwide, the
population with pre-
diabetes has reached
approximately
318 million
accounting for 6.7% of
total adults

69.2%
of the pre-diabetes
population lives in low-
or middle-income
countries

Zhao M, Lin H, Yuan Y, et al. Prevalence of Pre-Diabetes and Its Associated Risk Factors in Rural Areas of Ningbo, China. Int. J. Environ. Res. Public
Health. 2016;13:808.
 Prevalence in India

Studies in India have shown

that nearly 40–55% of the
people with pre-diabetic stage
will develop type 2 diabetes
mellitus over a period
of 3–5 years

Muthunarayanan L, Ramraj B, and Russel JK. Prevalence of prediabetes and its associated risk factors among rural adults in Tamil Nadu. Arch Med Health Sci . 2015;3:178–84.
 Risk Factors
• Multiple risk factors are related to pre-diabetes including:

Being Overweight Increasing Age

Blood Pressure Dyslipidemia

Zhao M, Lin H, Yuan Y, et al. Prevalence of Pre-Diabetes and Its Associated Risk Factors in Rural Areas of Ningbo, China. Int. J. Environ. Res. Public Health.
2016;13;808.
 Health Risks Associated with Pre-
diabetes
Progression to diabetes
• In a meta-analysis in 2007 evaluating the progression of pre-diabetes to
diabetes, the annual incidence rate of diabetes was found to be
• 4%–6% for isolated IGT
• 6%–9% for isolated IFG
• 15%–19% for both IGT and IFG
Nephropathy and kidney disease
• Several studies have shown pre-diabetes is associated with increased
risk of chronic kidney disease and early nephropathy
• This association may be due to increased incidence of diabetes or the
presence of other factors associated with both hyperglycemia and
nephropathy
Bansal N. Prediabetes diagnosis and treatment: A review. World J Diabetes. 2015;6(2):296–303.
 Health Risks Associated with
Pre-diabetes
Neuropathies
• Pre-diabetes is found to be associated with dysfunction of cardiac
autonomic activity reflected by
• Reduced heart rate variability
• Decreased parasympathetic modulation of the heart
• Increased prevalence of male erectile dysfunction in individuals
with pre-diabetes
• There is also increasing evidence to demonstrate a higher frequency of
idiopathic polyneuropathy, painful sensory neuropathy, and small fiber
neuropathy among prediabetic individuals with IGT

Bansal N. Prediabetes diagnosis and treatment: A review. World J Diabetes. 2015;6(2):296–303.

 Health Risks Associated with
Pre-diabetes
Retinopathy
• In the Diabetes Prevention Program (DPP) study, about 8% of
participants with prediabetes were found to have evidence of diabetic
retinopathy
Macrovascular disease
• Pre-diabetes has been associated with increased risk of developing
macrovascular disease
• Studies have shown an increased prevalence of coronary heart disease
in individuals with pre-diabetes

Bansal N. Prediabetes diagnosis and treatment: A review. World J Diabetes. 2015;6(2):296–303.

 Treatment
Lifestyle interventions
• 56% reduced risk of future diabetes with effective lifestyle interventions
• Lifestyle interventions decreased the risk of diabetes up to 10 years after a
lifestyle intervention
• In the 20-year follow-up of the Da Qing Diabetes Prevention Study, those
receiving a lifestyle intervention had a 51% lower incidence of diabetes
 Treatment
• A study showed that for every 1 kg decrease in weight, the risk of
developing diabetes in future was reduced by 16%
• The theme of lifestyle intervention programs is to change the
modifiable risk factors of pre-diabetes and diabetes by targeting
obesity with

Increased Physical Activity Dietary Changes

Bansal N. Prediabetes diagnosis and treatment: A review. World J Diabetes. 2015;6(2):296–303.
 Treatment
• Lifestyle changes such as weight loss (7% of body weight) and moderate
physical activity (150 minutes per week) can reduce the risk of diabetes by as
much as 58%

Tuso P. Prediabetes and Lifestyle Modification: Time to Prevent a Preventable Disease. Perm J. 2014;18(3):88–93.
 Treatment

Available from: http://www.heart.org/HEARTORG/Conditions/More/Diabetes/AboutDiabetes/Prevention-and-Treatment-for-Pre-diabetes_UCM_461557_Article.jsp#.WpOYMx1ubIV. Accessed on

February 26, 2018.
 Conclusion
• Pre-diabetes is an intermediate state of hyperglycemia with glycemic
parameters above normal but below the diabetes threshold
• It remains a state of high risk for developing diabetes with yearly
conversion rate of 5%–10%
• Pre-diabetes leads to complications such as early nephropathy, small-fiber
neuropathy, early retinopathy, and risk of macrovascular disease
• Several studies have shown efficacy of lifestyle interventions including
increased physical activity and diet modification reducing 40%-70% in
adults with pre-diabetes progression to diabetes