Pre-diabetes: Risk Factors & Diagnosis

1. Pre-diabetes: Risk Factors & Diagnosis Saoirse Ní Chuirrín DNS Caitriona Lordan Dietitian September 2015

2. What is pre-diabetes? • This is a condition in which blood glucose levels are higher than normal but not high enough to be diagnosed as Type 2 Diabetes. • Pre-diabetes is the new term used for individuals with impaired fasting glucose (IFG) or impaired glucose tolerance (IGT). Previously ‘borderline diabetes’. Saoirse Ní Chuirrín Bon Secours Hospital

3. So what’s the difference? 2 different pathophysiological mechanisms! • IFG – high after a period of fasting • IGT – high post prandial Saoirse Ní Chuirrín Bon Secours Hospital

4. Diagnosis ADAGuidelines • Fasting plasma glucose 5.6 – 6.9mmol/l (IFG) or • 2 hour result in the 75g OGTT 7.8- 11.0mmols (IGT) or • HbA1c 39 - 46mmol/mol (5.7 -6.4%) Saoirse Ní Chuirrín Bon Secours Hospital

5. Diagnosis WHO • Fasting plasma glucose 6.1 – 6.9mmols/l and • 2 hour result in the 75g OGTT 7.8- 11.0mmols (IGT) HbA1c alone not recommended for diagnosis Saoirse Ní Chuirrín Bon Secours Hospital

6. Diagnosis - Our approach! • Fasting plasma glucose 6.1 – 6.9mmols/l WITH • 2 hour result in the 75g OGTT 7.8- 11.0mmols (IGT) OR • HbA1c –guide 39 - 46mmol/mol (5.7 -6.4%) *FPG alone could mean diabetes may go undiagnosed! Saoirse Ní Chuirrín Bon Secours Hospital

7. Prevalence • Ireland • VHI Health screening project 2009 – 2013. 30,000 Participants 11.8%- abnormal glucose levels • IDF 2014 – estimate 70,600 undiagnosed cases of diabetes in Ireland. Saoirse Ní Chuirrín Bon Secours Hospital

8. Significance? • Indicates an increased future risk of developing Type 2 Diabetes • Increased risk of CVD • Increased risk of microvascular complications • Associated with obesity Saoirse Ní Chuirrín Bon Secours Hospital

9. Who to screen? • All adults who are overweight (BMI >25) • High risk race – e.g.African American,Asian, Latino. • Physically inactive • Family history of diabetes • Hypertension/CVD • High triglycerides or high total cholesterol Saoirse Ní Chuirrín Bon Secours Hospital

10. Who to screen? • Women who have delivered a baby >9lbs or who have had gestational diabetes • Women with polycystic ovary syndrome • Previous abnormal result Saoirse Ní Chuirrín Bon Secours Hospital

11. Treatments Priority- Reduce insulin resistance! • ↑ physical activity • Improving dietary choices • Weight management & weight loss programmes • ?Metformin – delay conversion to diabetes • Mange risk factors – smoking, cholesterol, BP Saoirse Ní Chuirrín Bon Secours Hospital

12. US- Diabetes Prevention Programme(DPP) • 3234 participants – Pre-diabetes/overweight 1)Lifestyle intervention group – intensive training on diet/exercise/behaviour modification 2)Metformin group – also info on diet/exercise 3)Placebo – info diet/exercise Saoirse Ní Chuirrín Bon Secours Hospital

13. DPP 1) Lifestyle- ↓the risk by 58% Diabetes developed in 14% 2) Metformin - ↓the risk by 31%. Diabetes developed in 22% 3) Placebo pills – diabetes developed in 29% Weight loss & physical activity works! Saoirse Ní Chuirrín Bon Secours Hospital

14. Saoirse Ní Chuirrín Bon Secours Hospital

15. Caitriona Lordan- Dietician Saoirse Ní Chuirrín Bon Secours Hospital

16. Behavioural Strategies • Shop with a list and stick to it • Don’t shop when hungry • Take someone supportive with you • Shop the perimeter of the store Caitriona Lordan Bon Secours Hospital

17. Behavioural Strategies • Do not be tempted by “bargains” • Freeze extra food • Use opaque containers in the fridge • Avoid preparing too much food • Avoid tasting food when preparing Caitriona Lordan Bon Secours Hospital

18. Behavioural Strategies • Eat in one room at a table • Use smaller plates • Put knife and fork down between mouthfuls • Half the plate should be vegetables or salad • Don’t use food as a reward Caitriona Lordan Bon Secours Hospital

19. Unhelpful Thinking Styles • Black and white thinking • Catastrophising • Minimising the good things Caitriona Lordan Bon Secours Hospital

20. Enjoy your food Caitriona Lordan Bon Secours Hospital

21. Thank you! Saoirse Ní Chuirrín Bon Secours Hospital