There has been a concerning rise in the prevalence of prediabetes in the Indian population. Thus, it appeared appropriate to create a proactive strategy for managing prediabetes. This article enlightens doctors with some valuable recommendations to treat prediabetic patients. 

Experts in India have come together to provide a consensus statement on how to treat prediabetes, and their findings were just published in the JAPI (Journal of the Association of Physicians in India).

Prediabetes conditions are quickly transformed into diabetes among Asian Indians. Additionally, prediabetes increases the risk of developing macrovascular and (to a lesser degree) microvascular problems of diabetes.

In a comprehensive community-based epidemiological investigation, the ICMR-INDIAB (Indian Council of Medical Research–India Diabetes) revealed an overall prediabetes prevalence of 10.3% across 15 Indian states. Prediabetes should be seen as a chance to avoid diabetes rather than as a road to the disease.

The consensus declaration suggested strategies for prediabetes screening and pharmacological and lifestyle treatment in Asian Indians. Numerous nations have implemented lifestyle programmes for diabetes prevention and, where necessary, metformin pharmaceutical intervention. The agreement on early identification and treatment will prevent the development of prediabetes into diabetes and its accompanying problems. It will also assist improve awareness for screening and risk stratification of persons with prediabetes which may aid clinicians in identifying appropriate therapies.

Recommendations for preventing type 2 diabetes in people with prediabetes

1. The researchers advise 6–8 hours of sleep every day.
2. For those who are overweight or obese, the experts advise decreasing 5–10% of their body weight, maintaining a healthy weight starting during pregnancy, and tracking calories.
3. Juices, refined cereals, and trans fats should all be consumed in moderation, according to the investigators. Simple carbohydrates and saturated fats should also be avoided in moderation.
4. All meals have a sufficient amount of fibre.
5. The experts emphasise the significance of tailoring the percentage of calories from fat and carbs to each person's therapeutic objectives.
6. The authors advise engaging in everyday physical activity such as swimming, brisk walking, cycling, dancing, or outdoor sports.
7. Five days a week, 30 minutes of exercise should be done.
8. It's recommended to do some exercise at least five times a week to maintain mobility.
9. Yoga is a potential complement to exercise.
10. The threshold for the action of pharmacological therapy should be based on: The severity of hyperglycemia, one's perception of its severity, and one's susceptibility, such as those who are more likely to experience worsening dysglycemia, develop CV complications, develop diabetes, or have a positive family history; and support from the system, such as financial assistance for the patient.

Metformin use in the prevention of diabetes: Recommended practices

1. For the prevention of type 2 diabetes (T2D), metformin medication should be explored in people with prediabetes, BMI >35 kg/m2, age 60 or older, and women who have had gestational diabetes in the past.
2. In patients with poor glucose tolerance, metformin may lower the risk of T2D. (IGT).
3. Metformin should be used 250–850 mg/day if lifestyle changes are not adequate to reduce body weight and improve glucose tolerance.

Other important conclusions from the consensus

1. The Indian Diabetes Risk Score (IDRS) screening tool may be used to identify individuals who have clinical risk factors for prediabetes.
2. As prediabetes raises the risk of CVD events, stroke, myocardial infarction, and CV mortality, the risk for macrovascular disease begins to develop.
3. Biomarkers make it possible to identify those who are at a greater risk of acquiring diabetes.
4. Retinopathy, neuropathy, and nephropathy are further conditions associated with prediabetes.
5. Prediabetes must be recognised and actively treated.
6. Biomarkers make it possible to identify those who are at a greater risk of developing diabetes.
7. The treatment of prediabetes depends on lifestyle changes.
8. Metformin reduces diabetes, especially in younger and obese people, according to large, randomised clinical studies.
9. The only pharmaceutical indicated for delaying or preventing T2D is metformin.

Filling the void

Prediabetes is well-known to all doctors and medical professionals. However, there seems to be a disconnect between people's knowledge and their willingness to implement preventative measures.

The only way to close the gap is via:

• Open lines of dialogue
• The dissemination of relevant information
• The education of relevant parties
• The promotion of reasonable, practical, and effective measures

This is feasible via shared decision-making, in which the person with diabetes, their doctor, and their carer all have access to the same information. The goal is to zero down on the most viable solutions for the patient's specific problem. Doctors should have the authority to provide sound guidance. Collaboration amongst peers in making decisions is also required.

Disclaimer- The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of M3 India.

About the author of this article: Dr Monish Raut is a practising super specialist from New Delhi.