Recent studies have shown that almost 12% of Malaysians suffer from prediabetes, a health condition that if left unrecognised, is a major risk factor for developing diabetes. It is estimated that about 1 in 10 people with prediabetes will become diabetic annually. As the saying goes, prevention is better than cure. Effective blood glucose management can almost halve the risk of associated complications such as diabetic eye, kidney and nerve diseases.
Prediabetes is considered a separate entity to diabetes. The distinctive feature that separates it from diabetes is that although the levels are high, they do not reach the criteria required to diagnose type 2 diabetes. Interchangeable terms for prediabetes are impaired fasting glucose and impaired glucose tolerance, based on the diagnostic tests which are the fasting blood glucose levels or the Oral Glucose Tolerance Test (OGTT).
The dilemma with prediabetes is that most patients are asymptomatic and are hence unaware that they have this condition. Due to the high number of young adults diagnosed with diabetes, annual diabetic screening is recommended to start from the age of 30. Screening for adults under 30 is recommended for people with risk factors such as obesity, high blood pressure, abnormal lipid levels, a pregnancy history of gestational diabetes or having a large baby, or a positive family history for diabetes.
The decision to screen for diabetes should be made during a consultation with a family physician or the treating doctor for risk stratification and further management. If the first check for prediabetes comes back negative, patients will undergo follow-up screenings every 1-3 years, depending on their risk factors.
People react in different ways when they receive a perplexing diagnosis like prediabetes. It is common to feel anger, guilt, and sadness, while some may choose to simply avoid and ignore the matter instead. The false assurance that is sometimes associated with prediabetes may result in a person becoming ignorant of its dangers. There has been strong evidence linking prediabetes with an increased risk of heart disease, stroke, and cancer. Addressing prediabetes is a complex task for both healthcare professionals and patients, as balancing effective management strategies with the accompanying stress and anxiety can be challenging.
For prediabetics, current research underscores the importance of a balanced diet that
promotes healthy blood glucose levels and weight. It is recommended to prioritise whole foods, such as an array of vegetables, lean proteins, whole grains, and healthy fats, while minimising the intake of processed food, added sugars and refined carbohydrates. Keeping well hydrated and preventing sugar intake in drinks will also contribute to optimal blood sugar levels. The World Health Organisation (WHO) recommends consuming 6-8 glasses of drinking water a day and eating at least 3 portions of vegetables and 2 portions of fruits daily.
The Malaysian healthy plate diet is one that is formulated to promote healthy eating and should be practised by prediabetics too. It is also known as the “suku-suku-separuh” technique. This model describes a 10-inch round plate that is divided into 4 quarters: 1 quarter filled with protein such as fish or chicken, 1 quarter filled with carbohydrates such as rice or noodles (preferably brown rice or noodles which has a higher content of fibre), and half the plate or 2 quarters filled with a mixture of 2-3 types of vegetables and fruits. To complete each meal, it is also recommended to have a glass of water or a sugar-free drink.
It is advised that people with prediabetes engage in 150 minutes per week of moderate-intensity aerobic exercises such as cycling, swimming, brisk walking, or jogging. It is essential that a person finds an activity that they enjoy and schedule it into their routine. Starting slowly and subsequently increasing the frequency, intensity and duration of the exercise has been suggested for those with difficulties initiating and maintaining a regular exercise regime.
Measures that incorporate an increase in physical activity into one’s daily life such as parking further away from the entrance and using public transportation will increase the walking distance and ultimately the daily step count. Smart wearables that track a person’s steps and fitness levels have also been shown to promote an active lifestyle. Getting involved in group or community activities such as Tai Chi or Yoga will not only increase one’s physical activity level but can enhance socialisation and boost mental wellbeing too.
Given the rising rates of obesity among both children and adults in our country, it is essential to maintain a healthy weight. Regularly monitoring one’s Body Mass Index (BMI) and waist circumference can heighten awareness of one’s health, motivating them to stay within the advised weight limit. Engaging in regular exercise and reducing body weight by just 10% can significantly enhance insulin sensitivity, which will ultimately result in a lower risk of diabetes and heart disease.
For smokers, the benefits of quitting extend from improved cardiac health to enhanced blood glucose control and beyond. However, the profound addiction to cigarettes presents a significant challenge, even for those deeply committed to quitting. Often, multiple attempts and treatments are needed to achieve long-term abstinence. The likelihood of successfully quitting increases when individuals participate in structured smoking cessation programs. Such services are readily available in both government and private general practice clinics nationwide.
There is an ongoing debate among healthcare professionals regarding alcohol consumption and health in general. It’s imperative that individuals consult with their doctors before deciding regarding this matter. For prediabetics who drink alcohol, the general advice is to drink in moderation. This is defined as 1 drink or less in a day for women and 2 drinks or less in a day for men.
Medical conditions linked to diabetes such as Obstructive Sleep Apnoea (OSA) and hypothyroidism should be treated as these diseases are associated with abnormal blood glucose levels. Additionally, effective management of problems such as stress and lack of sleep is paramount when a person embarks on a journey of lifestyle modification.
A personalised lifestyle intervention has proven effective in reversing prediabetes in adults. This comprehensive approach includes a personalised nutritional plan, exercise regimen, behavioural change strategies, and self-empowerment measures.
The key take-home message is that early detection is pivotal. Public awareness of the risks of having this condition should be enhanced, in parallel with screening efforts. Individuals who receive this diagnosis should not be discouraged and anticipate a bleak future. Instead, they should view it as a wakeup call and take necessary actions by initiating lifestyle modifications. Begin with small yet consistent changes rather than big, drastic measures as this will improve compliance to the actions, ultimately yielding better outcomes.
