Healthcare Administration and Diabetes

Pre-diabetes Condition

Burden of disease: disability/morbidity

The word 'pre-diabetes' applies to persons highly susceptible to contracting diabetes mellitus (type 2). Those diagnosed as pre-diabetic have sustained, higher-than-normal blood glucose levels; however, these levels are not sufficiently high to be characterized as diabetes. Pre-diabetics suffer from either IGT (impaired glucose tolerance), or IFG (impaired fasting glucose), or both. The former denotes a condition wherein glucose tolerance levels of individuals after two hours of glucose consumption lie between 140 and 199 milligrams/deciliter whereas the latter refers to a condition wherein fasting blood glucose levels lie between 100 and 125 milligrams/deciliter (when nothing has been consumed throughout the night) (Thomaskutty & Dwivedi, 2011).

After pre-diabetes sets in, beta cells lose their function progressively, resulting in the onset of diabetes. Type 2 diabetics characteristically have by high blood sugar levels, a condition that, with time, damages blood vessels and nerves, thereby giving rise to complications like heart disease, kidney failure, lower-limb amputation, stroke, and blindness, among others. Research has depicted that a majority of pre-diabetics become diabetics in a ten-year span if they fail to alter their existing lifestyle. Lifestyle modifications imply a loss of 5-7% of their current body weight (for instance, between 10 and 14 lbs. for an individual weighing 200 lbs.) by altering their physical activity levels and diet (Prediabetes and Insulin Resistance, 2009).

Current Scenario

Pre-diabetics are increasing at an alarming rate in the U.S., with DHHS (Department of Health and Human Services) figures of the year 2012 claiming that a minimum of 86 million citizens above twenty years were pre-diabetics (Prediabetes and Insulin Resistance, 2009).

On a global scale, pre-diabetes is growing in prevalence, and can set in anywhere between seven and ten years prior to clinical diabetes diagnosis. At this juncture, risk factors typically exist and grow, including higher risks of contracting cardiovascular disease. Similarly, cardiovascular disease onset, particularly CAD (coronary artery disease), cerebrovascular disease, and peripheral vascular disease may transpire as well, which lead to elevated global mortality and morbidity levels (Magalhaes, Cavalcanti & Cavalcanti, 2010).

Several sources have issued pre-diabetes prevalence figures, which depict pre-diabetes levels between 5.8 and 35% in individuals aged 20+. Reported rates differ based on what criteria are utilized for defining pre-diabetes. Nevertheless, the condition has grown in prevalence in the past few decades. 1988-94 and 1999-2010 National Health and Nutrition Examination Survey data comparisons reveal that pre-diabetes grew in prevalence from about 5.8% to 12.4% in these duration. It is predicted that in the absence of intervention, between 15 and 30% of pre-diabetics will contract diabetes (type 2) in five years' time (Endocrine Society, 2015).

Etiology-cause: distribution of disease

Individuals who develop insulin resistance become increasingly prone to developing the condition of pre-diabetes. The condition normally surfaces among individuals with existent insulin resistance. While this is not the only factor leading to pre-diabetes, insulin resistance normally sets the scene for its onset, by greatly taxing insulin-generating beta cells. Beta cells of pre-diabetics stop secreting sufficient insulin for overcoming insulin resistance, thus resulting in slightly elevated blood sugar levels (Prediabetes and Insulin Resistance, 2009).

The condition sets in when an individual's body loses the capacity of properly maintaining normal blood sugar levels. While blood sugar levels are elevated compared to normal figures, they are not sufficiently high to be characterized as diabetes. Whatever one consumes is converted into sugar, and the human body uses up this sugar for energy. Under ordinary conditions, the pancreas secretes insulin, a hormone that facilitates blood sugar entry into the human body's cells. However, when the body cannot utilize insulin properly, glucose fails to move into body cells and remains in the person's blood. This condition is termed as insulin resistance.

Sugar accumulation in an individual's blood results in pre-diabetes. This condition will develop into diabetes mellitus type 2 when sustained elevated levels of blood sugar remain in a person's blood. Furthermore, physically inactive individuals, obese/overweight individuals and those with diabetes running in the family are highly susceptible to pre-diabetes. Lastly, females with gestational diabetes (diabetes during pregnancy) are also a high-risk group (Prediabetes, 2014).

Further, a difference has been observed in pre-diabetes distribution among ethnically different groups of people. A 2005-08 National Health and Nutrition Examination Survey data analysis depicted similar pre-diabetes rates among Non-Hispanic White individuals (35%), Mexican-American (36%) and Non-Hispanic Black individuals (35%). The 2010 National Health and Nutrition Examination Survey data was utilized to conduct a research work, which discovered gender differences based on ethnicity: pre-diabetes rates were consistent across females from different ethnic populations; however, rates were lower in non-Hispanic black men as opposed to Mexican-American or non-Hispanic White men (Endocrine Society, 2015).

Recommendation

Healthy diet and lifestyle choices aid pre-diabetics in normalizing their blood glucose levels. As a minimum, such choices can help prevent blood glucose levels from growing to 'diabetic' levels. But despite successful weight loss, some individuals eventually develop diabetes mellitus type 2. The following recommendations are provided to prevent pre-diabetes' progress to diabetes (type 2):

• Healthy eating. Pre-diabetes should opt for low-fat, low-calorie, and high-fiber foods, like whole grains, fruits and vegetables. To ensure they are not sacrificing nutrition or taste when working towards these goals, they can opt for variety. A Mediterranean-style food plan appears to be ideal for pre-diabetics.

• Increased physical activity. Pre-diabetics must engage in moderate-level physical activity between 30 and 60 minutes almost every day. They must ensure they never go more than a couple of days without engaging in some form of exercise. Brisk-walking, swimming, cycling, etc. are ideal activities for pre-diabetics. For individuals have no time for long workouts, smaller sessions that are spread across the day should be attempted. The ADA (American Diabetes Association) advises pre-diabetic persons take to exercises such as weightlifting and other resistance training, twice per week.

• Losing extra weight: For overweight individuals, a 5-10% body weight loss (e.g., 10-20 lbs. (4.5-9 kg) for a 200 lbs. (91 kg) individual) lessens diabetes development risks among pre-diabetics. For weight maintenance at healthy levels, pre-diabetics must achieve permanent changes in their exercise and eating habits, and should derive motivation from the advantages of weight loss (e.g., a healthier body and heart, increased self-esteem, more energy, etc.).

• Consuming medicines as required: Metformin (or Glucophage), doctors occasionally recommend an oral drug for sugar control for high-risk pre-diabetics (including individuals with >35 BMI (body mass index), females with gestational diabetes history, and individuals aged below 60 years). Although they do not stop diabetes from ever occurring, such medications for blood pressure and cholesterol control may also be administered/prescribed whenever required (Mayo Clinic, 2014).

Implementation: systematic process and method to instill effective and efficient control and change.

Weight loss, increased activity, and healthy eating are necessary changes to implement in one's life. They are the ideal things to do in order to prevent the onset of pre-diabetes and to prevent an existing pre-diabetes condition from developing into diabetes. The following implementation steps are great starting blocks:

Knowledge about importance of change: Mulling on why one wishes to make a lifestyle change prior to establishing goals is a valuable first step. A reason that comes from within, rather than from others makes it easier to implement change. For instance, one might wish to evade the hassles linked to diabetes (e.g., blood glucose testing, taking insulin injections, etc.). Alternatively, one might be worried about associated health issues; or an individual may merely wish for a healthier life, in order to enjoy it better. The reason behind change is a very important factor.

Establishing goals for the long- and short-term: A pre-diabetic must begin by establishing one major goal for the long run (for instance, a 10-percent weight loss for reducing diabetes onset risks). Hence, an individual weighing 200 lbs. would have to set a target of losing 20 lbs. This major goal may be broken down into many small goals with short-term deadlines. All these steps together will help achieve the main goal. Every individual must do whatever works most effectively for him/her. Establishing doable goals is imperative. For instance:

Week 1: Walk nearly all days a week for about 15 minutes.

Week 2: Keep up this walking program, but when snacking this week, have only celery sticks, carrots, and strictly not crackers, or potato chips.

Week 3: Continue eating nutritious, fat-free snacks and maintain this walking program. Slowly increase the walking duration to half an hour, most days of the week and pay close attention to hunger levels at mealtimes. Cease eating the moment your stomach feels full.

Preparing for obstacles and slip-ups: Pre-diabetics should anticipate and plan for unforeseen setbacks. An action plan ought to be utilized, where one notes one's (What is a PDF document?)goals, potential roadblocks, and how to surmount them. Considering obstacles now will help an individual effectively plan ahead and decide how to tackle them should they actually surface.

Getting support: Pre-diabetics must inform kith and kin about why they wish to alter their lifestyle. It is imperative that they know their motivation and encouragement will make a huge difference to their goal of preventing diabetes onset. Support may also be sought from a counselor or the doctor.

Getting medication: Doctors normally prescribe Glucophage or metformin for pre-diabetics who need medicine. This drug reduces the amount of glucose made by the liver, and is also capable of reducing insulin resistance. Pre-diabetics must discuss whether medication is needed for decreasing insulin resistance, aside from lifestyle changes, with their doctor (Prediabetes, 2014).

References

Endocrine Society. (2015). Prediabetes. Retrieved October 1, 2016, from http://endocrinefacts.org/health-conditions/diabetes-2/2-prediabetes/

Magalhaes, M. E. C., Cavalcanti, B. A., & Cavalcanti, S. (2010). Could pre-diabetes be

considered a clinical condition? opinions from an endocrinologist and a cardiologist. Diabetology & metabolic syndrome, 2(1), 1.

Mayo Clinic (2014). Prediabetes treatments and drugs. Retrieved October 1, 2016, from http://www.mayoclinic.org/diseases-conditions/prediabetes/basics/treatment/con-20024420

Prediabetes and Insulin Resistance. (2009). Retrieved October 1, 2016, from https://www.niddk.nih.gov/health-information/diabetes/types/prediabetes-insulin-resistance

Prediabetes. (2014). Retrieved October 1, 2016, from Webmd,

http://www.webmd.com/diabetes/tc/prediabetes-cause

Thomaskutty, C and Dwivedi, PK (2011). Burden of Diabetes in Indiana. Indiana State

Department of Health, Indianapolis, Indiana