Prediabetes: What It Is, Symptoms, and How to Prevent It
Prediabetes is a serious condition that can lead to type 2 diabetes and other health problems. It is reversible with healthy lifestyle changes, so it is important to get tested and take action to stay healthy.
DR TS DIDWAL MD
10/4/20235 min read
Prediabetes, often referred to as "borderline diabetes," is a condition that can serve as a harbinger of more severe health issues, including type 2 diabetes, heart disease, kidney problems, eye complications, and even certain types of cancer. Recent groundbreaking research conducted by scientists in Germany has shed light on a promising path toward reversing prediabetes and reducing the associated risks. This remarkable study demonstrates that adopting a healthy diet and increasing physical activity can lead to improved insulin sensitivity, especially by targeting the reduction of visceral fat—abdominal fat that surrounds vital organs. The implications of this research are profound, suggesting that targeted weight loss, specifically focusing on abdominal fat, could be a key factor in reversing prediabetes.
Understanding Prediabetes: The Silent Health Threat
Prediabetes is characterized by elevated blood sugar levels that do not yet meet the criteria for a diabetes diagnosis. However, this should not be taken lightly, as the Centers for Disease Control and Prevention (CDC) warns that without intervention, many individuals with prediabetes could progress to type 2 diabetes within five years. This condition, affecting a staggering 96 million adults in the United States, often lurks in the shadows, with a shocking 80% of affected individuals unaware of their predicament.
Differentiating Prediabetes Remission
While the concept of diabetes remission is well-known, prediabetes remission is a distinct phenomenon marked by enhanced insulin sensitivity and reduced visceral adipose tissue (VAT). The research conducted at the Center for Diabetes Research (DZD) in Germany sought to unravel the mechanisms through which weight loss might induce remission in individuals with prediabetes. Their findings add to a growing body of evidence highlighting the profound impact of lifestyle and dietary choices on metabolic function and the onset—or reversal—of diabetes symptoms. Notably, this research suggests that achieving prediabetes remission may also lead to improved long-term kidney and vascular function.
Taking Early Action to Reverse Prediabetes
Given the heightened risk of developing type 2 diabetes in individuals with prediabetes, health experts have been fervently exploring strategies to thwart its progression. In a bid to extend the concept of diabetes remission to prediabetes, Professor Dr. Andreas Birkenfeld, medical director of Medical Clinic IV at Tübingen University Hospital, and director of the Institute for Diabetes Research and Metabolic Diseases of Helmholtz Munich at the University of Tübingen, led a pioneering effort. Their goal was clear: to initiate preventive measures at the prediabetes stage, potentially reversing it.
The Critical Role of Insulin and Body Fat
The primary outcomes of this groundbreaking study revolved around insulin sensitivity and secretion, visceral adipose tissue (VAT), and intrahepatic lipid content (IHL). VAT, which accumulates in the abdominal cavity and surrounds vital organs, is believed to trigger an inflammatory response that negatively affects insulin sensitivity. High levels of intrahepatic lipid content have been associated with insulin resistance, type 2 diabetes, and a host of heart and liver conditions.
Unveiling the Study's Methodology
To unravel the mysteries of prediabetes remission, researchers delved into the Prediabetes Lifestyle Intervention Study (PLIS). This comprehensive investigation involved recruiting 1,160 subjects from eight clinical study centers in Germany over a period spanning from 2016 to 2021. Volunteers were divided into groups receiving various lifestyle interventions, including standard Diabetes Prevention Program (DPP)-based interventions and control groups. DPP participants, selected between 1996 and 1999, were randomly assigned to standard lifestyle interventions, metformin, or placebo. Responders were those who achieved remission by achieving healthy fasting plasma glucose levels, glucose tolerance, and HbA1c levels below 39 mmol/mol after 12 months of intervention. Non-responders, despite weight loss, maintained levels above these thresholds.
Remission Tied to Insulin Sensitivity
Among the 298 individuals in the PLIS who lost 5% or more of their baseline body weight, 43% were classified as responders, while 57% were non-responders. Surprisingly, there was no significant difference in relative weight loss between the two groups. What set responders apart was their remarkable improvement in insulin sensitivity, despite no changes in insulin secretion—a crucial distinction from type 2 diabetes remission, which hinges on increased insulin secretion.
The Influence of Abdominal Fat on Insulin Sensitivity
Comparative analysis of the two groups revealed the key to improved insulin sensitivity in responders: the loss of abdominal fat. Even though both groups shed the same amount of body weight, those who achieved remission experienced a significant reduction in abdominal fat. Specific waist reduction thresholds were identified, with over 4.5 cm for women and 7.4 cm for men emerging as predictive markers for remission. This finding underscores the pivotal role of abdominal fat in the development and reversal of prediabetes.
Expert Insights on Fat Loss and Prediabetes Reversal
Kimberly Gomer, a renowned dietitian, and director of nutrition at Body Beautiful Miami in Miami, Florida, emphasized the connection between fat loss and prediabetes reversal. She stated, "The more insulin-resistant a person is, the more they are at risk for prediabetes and diabetes. In my private practice, I have always seen prediabetes and diabetes improve and many times go into remission when weight loss is achieved." Gomer further elucidated the link between prediabetes and belly fat, noting that the reduction of belly fat, including visceral fat, alleviates insulin resistance and improves blood sugar control.
Study Limitations and Future Implications
Kelsey Costa, a registered dietitian nutritionist and research communicator based in Connecticut, acknowledged the strengths of the research but highlighted the use of surrogate parameters for insulin sensitivity and secretion. Nevertheless, these markers align closely with direct measurements. The researchers also recognized potential confounders, such as genetic and environmental factors, and cautioned that the findings may not apply to low-income countries with limited access to medical care. Moreover, the study's predominantly white participant pool raises questions about generalizability to other ethnic groups.
Preventing Prediabetes and Type 2 Diabetes
As we navigate the intricacies of prediabetes and its potential reversal, it's essential to explore preventive measures. Costa recommended innovative lifestyle interventions, including adopting a healthy plant-based diet and incorporating intermittent fasting. These approaches have shown promise in improving insulin sensitivity and reducing the risk of diabetes. Additionally, exercise, stress management techniques, and adequate quality sleep all play pivotal roles in preventing prediabetes and type 2 diabetes.
A New Therapeutic Frontier
Professor Reiner Jumpertz-von Schwartzenberg, co-first author of the study, expressed a paradigm shift in the approach to prediabetes. He asserted, "Based on the new data, remission should be the new therapeutic target in people with prediabetes. This has the potential to change treatment practice and minimize the complication rate for our patients." Furthermore, the criteria for prediabetes remission established in this research could serve as valuable biomarkers for identifying individuals at risk for prediabetes.
In conclusion, prediabetes, often overlooked, is a critical precursor to more severe health conditions, including type 2 diabetes and associated complications. The groundbreaking research from Germany underscores the significance of lifestyle interventions, particularly
Reference Articles
1.Sandforth, A., von Schwartzenberg, R. J., Vazquez Arreola, E., Hanson, R. L., Sancar, G., Katzenstein, S., … Birkenfeld, A. L. (2023). Mechanisms of weight loss-induced remission in people with prediabetes: a post-hoc analysis of the randomised, controlled, multicenter Prediabetes Lifestyle Intervention Study (PLIS). The Lancet Diabetes & Endocrinology, 11(11), 798-8101
2.Prediabetes - Your Chance to Prevent Type 2 Diabetes. (2021, December 21). Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/basics/prediabetes.html
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