Pre-diabetes – Helping patients fight the silent precursor to type 2 diabetes


By Dr Ginni Mansberg, general practitioner - Sponsored by Dairy Australia. Advice and opinions are the author’s own.


Over one million Australians have been diagnosed with diabetes, most of them with type 2 diabetes. More recently, we are beginning to recognise the issue of pre-diabetes. 

  

Very few of my patients have heard of it yet, one in four Australians over the age of 25 are living with pre-diabetes(1). Many don’t know they have the condition because there are no symptoms. On the down side, living with pre-diabetes means they are at high risk of developing type 2 diabetes, with a 5-10 per cent yearly conversion rate from pre-diabetes to type 2 diabetes. Pre-diabetes can also put people at higher risk of neuropathy, nephropathy and kidney disease, and retinopathy(2). But on the bright side, they have a chance to punt the condition altogether and even prevent type 2 diabetes.

Step one is to eat right, get enough exercise and get to a healthy weight. For my patients who have lived their life never really worrying about making healthy choices, I tell them that this is all about to change. This is because we know lifestyle changes can reduce a patient’s risk of developing type 2 diabetes by up to 58 per cent(3).

There is medication for pre-diabetes. Metformin, a sugar-lowering drug used for diabetes has been shown in studies to reduce the risk of developing type 2 diabetes by 45 per cent. Some GPs use this as a second line intervention after lifestyle changes. But there are no concrete guidelines as to when to introduce it.

What I tell my patients diagnosed with pre-diabetes

  1. Yes you do need more veggies. Use the Australian Dietary Guidelines to find out how many serves of vegetables you should be getting every day. For a simple user-friendly guide, use the Foods That Do Good Nutrition Calculator.
  2. Get your daily dairy right. Milk, cheese and yoghurt are not associated with an increased risk of diabetes in fact the Australian Dietary Guidelines suggest the opposite(4). Again, the Nutrition Calculator is a great guide for serve recommendations specifically put together for your age and gender.
  3. Coffee. Yes, studies show coffee drinkers are less likely to develop type 2 diabetes and you don't have to stick to just one a day(5).
  4. Go nuts. A small handful of nuts a day can reduce your risk of developing diabetes by 30 per cent(6). 
  5. Focus on having less junk food: Chips, cookies, soft drinks. While these foods deliver energy quickly, they have little nutritional value. 
  6. You are going to need to get moving. Try to get at least 30 minutes of exercise every day, or on most days. A brisk walk or any other exercise you enjoy doing is important. 

Celebrate the small wins

Getting patients to overhaul a highly-processed diet high in junk foods and sugary drinks encouraging them to exercise regularly is tough. I acknowledge this and openly share that I struggle to do this myself. I try to encourage my patients and not admonish them for noncompliance because I don’t want to drive them away. Every change they make is great. Every kilogram they lose is a win, even if they're still not in the healthy weight range.

There are no guidelines around diagnosing or treating pre-diabetes, which can be challenging for GPs. This is mainly because we've only recognised the problem relatively recently. If your patient is diagnosed with pre-diabetes, help them see it as the kick along they need to become truly healthy and reduce their risk of not only type 2 diabetes but other chronic conditions. Refer them to an Accredited Practising Dietitian for tailored advice.

References

1. Diabetes Australia: https://www.diabetesaustralia.com.au/pre-diabetes
2. Bansal, Nidhi. "Prediabetes Diagnosis And Treatment: A Review". World Journal of Diabetes 6.2 (2015): 296.
3. Lindstrom J, Louheranta A, Mannelin M, Rastas M, Salminen V, Eriksoon J. The Finnish Diabetes Prevention Study (DPS): Lifestyle intervention and 3-year results on diet and physical activity. Diabetes Care 2003; 26: 3230-3236.
4. National Health and Medical Research Council. Australian Dietary Guidelines, Canberra: Commonwealth of Australia; 2013.
5. Bhupathiraju, Shilpa N. et al. "Changes In Coffee Intake And Subsequent Risk Of Type 2 Diabetes: Three Large Cohorts Of US Men And Women". Diabetologia 57.7 (2014): 1346-1354.
6. Jiang, R, Manson, J, Stampfer, M, Liu, S, Willett, W, & Hu, F 2002, Nut and peanut butter consumption and risk of type 2 diabetes in women, Journal Of The American Medical Association, 288, 20, pp. 2554-2560.