Window period to keep type 2 Diabetes at bay

Mathew Korir discovered that his blood sugar level was high during a health workshop organised by his organisation in 2014.

Even though the measurements were above the normal range, his blood sugar had not yet reached the level that leads to the development of type 2 diabetes.

“I was told that I was hanging in the middle. My sugar level had got out of the safe zone but was not yet in the danger zone. Symbolically speaking, I was near the fire but hadn’t began burning yet,” said Korir.

He was advised to eat healthy and exercise more so as to bring back the sugar level to normal ranges and allay type 2 diabetes.

“But I didn’t take the advice seriously. Since I hadn’t been diagnosed with the disease yet, I thought I was still healthy. Plus I didn’t have anyone to guide me on what to eat or do. So I just went back to my normal life.”

About a year later, Korir ended up developing diabetes. He now has to rely on medication to manage a condition that could have easily been prevented, had he taken the guidance seriously

Based on the World Health Organisation (WHO) guidelines, a fasting blood sugar level of 7 mmol/L and above is the cut-off for type 2 diabetes diagnosis.

Patients like Korir, with an elevated blood sugar measurement of between 6.1 and 7 mmol/L are considered to be in the pre-diabetes state.

This means that their blood sugar level is higher than normal but not yet high enough to be type 2 diabetes.

The pre-diabetes status is considered as a warning sign or an indication that affected people could develop type 2 diabetes if they do not make some lifestyle changes.

The recommended healthy interventions to prevent pre-diabetic individuals from progressing to type 2 diabetes patients include eating healthy, being physically active and having a healthy weight.

Certain medications as well as medical procedures such as metabolic surgery — to enhance weight loss in obese patients and lower blood sugar levels — are also important.

In a past 3,200 participant study conducted by the US National Diabetes Prevention Programme, lifestyle interventions reduced the incidence of type 2 diabetes by 58 per cent in patients with pre-diabetes.

A 10-year follow up report revealed a 34 per cent decrease in the incidence of diabetes for the original study participants.

The results of the research and projected cost savings were so impressive that the Diabetes Prevention Programme is now a mandated benefit for people with pre-diabetes in the US.

Based on this study, a prescription medication known as metformin and other drug interventions were somewhat less effective than lifestyle changes, but also resulted in preventing or delaying the onset of diabetes.

Metabolic or weight loss surgery was more effective than lifestyle interventions at preventing diabetes onset. It had longer lasting benefits, with a relative risk reduction of 78 per cent.

Despite the significance of these lifestyle adjustments in the prevention of non-communicable diseases (NCDs), many individuals in the pre-diabetes stage fail to embrace them due low awareness about their benefits as well as financial constraints such as consultancy fees for nutritionist and fitness experts, as well as hospital costs for weight loss surgeries or treatments.

A recent study published in The Journal of the American Osteopathic Association shows that even though lifestyle interventions, medication and surgery are proven to delay or prevent type 2 diabetes in a majority of pre-diabetes patients, limited access to the often expensive treatments is fuelling rising rates of the disease.

“We know that it’s much more cost effective to prevent disease than to treat it, particularly when it comes to diabetes. The short-term focus on immediate costs means patients are missing out on the opportunity to keep their disease from progressing,” said Dr Jay Shubrook, lead author of the study who specialises in the treatment of diabetes.

“We have the tools to change the trajectory for millions of patients at risk for diabetes. Using them wisely will save not only money, but lives, in the long run.”

The researchers noted that screening for diabetes and pre-diabetes is critically important.

Without knowledge of their pre-diabetes status, affected people miss out on the opportunity to delay or prevent type 2 diabetes.

They also put themselves at risk for diabetes related complications including the damage of body organs such as heart, blood vessels and kidneys.

Government statistics from the Kenya Stepwise Survey for NCDs risk factors indicates that close to 90 (87.8) per cent of the country’s population has never been tested for raised blood sugar, which is used to detect diabetes.