pre-diabetes: risk factors & diagnosis saoirse ní chuirrín dns caitriona lordan dietitian...
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Pre-diabetes: Risk Factors & Diagnosis
Saoirse Ní Chuirrín DNS
Caitriona Lordan Dietitian
September 2015
Saoirse Ní Chuirrín Bon Secours Hospital
What is pre-diabetes?
This is a condition in which blood glucose levels are higher than normal but not high enough to be diagnosed as Type 2 Diabetes.
Pre-diabetes is the new term used for individuals with impaired fasting glucose (IFG) or impaired glucose tolerance (IGT). Previously ‘borderline diabetes’.
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So what’s the difference?
2 different pathophysiological mechanisms!
IFG – high after a period of fasting
IGT – high post prandial
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Diagnosis
ADA Guidelines Fasting plasma glucose 5.6 – 6.9mmol/l (IFG)
or 2 hour result in the 75g OGTT 7.8- 11.0mmols
(IGT)
or HbA1c 39 - 46mmol/mol (5.7 -6.4%)
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Diagnosis
WHO Fasting plasma glucose 6.1 – 6.9mmols/l
and 2 hour result in the 75g OGTT 7.8- 11.0mmols
(IGT)
HbA1c alone not recommended for diagnosis
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Diagnosis - Our approach!
Fasting plasma glucose 6.1 – 6.9mmols/l WITH 2 hour result in the 75g OGTT 7.8- 11.0mmols (IGT) OR HbA1c –guide 39 - 46mmol/mol (5.7 -6.4%)
*FPG alone could mean diabetes may go undiagnosed!
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Prevalence
Ireland VHI Health screening project 2009 – 2013.
30,000 Participants
11.8%- abnormal glucose levels
IDF 2014 – estimate 70,600 undiagnosed cases of diabetes in Ireland.
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Significance?
Indicates an increased future risk of developing Type 2 Diabetes
Increased risk of CVD Increased risk of microvascular complications Associated with obesity
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Who to screen?
All adults who are overweight (BMI >25) High risk race – e.g.African American,Asian,
Latino. Physically inactive Family history of diabetes Hypertension/CVD High triglycerides or high total cholesterol
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Who to screen?
Women who have delivered a baby >9lbs or who have had gestational diabetes
Women with polycystic ovary syndrome Previous abnormal result
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Treatments
Priority- Reduce insulin resistance! ↑ physical activity Improving dietary choices Weight management & weight loss programmes ?Metformin – delay conversion to diabetes Mange risk factors – smoking, cholesterol, BP
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US- Diabetes Prevention Programme(DPP) 3234 participants – Pre-diabetes/overweight
1)Lifestyle intervention group – intensive training on diet/exercise/behaviour modification
2)Metformin group – also info on diet/exercise
3)Placebo – info diet/exercise
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DPP
1) Lifestyle- ↓the risk by 58%Diabetes developed in 14%
2) Metformin - ↓the risk by 31%. Diabetes developed in 22%
3) Placebo pills – diabetes developed in 29%
Weight loss & physical activity works!
Saoirse Ní Chuirrín Bon Secours Hospital
Saoirse Ní Chuirrín Bon Secours Hospital
Caitriona Lordan- Dietician
Caitriona Lordan Bon Secours Hospital
Behavioural Strategies
Shop with a list and stick to it
Don’t shop when hungry
Take someone supportive with you
Shop the perimeter of the store
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Behavioural Strategies
Do not be tempted by “bargains”
Freeze extra food
Use opaque containers in the fridge
Avoid preparing too much food
Avoid tasting food when preparing
Caitriona Lordan Bon Secours Hospital
Behavioural Strategies
Eat in one room at a table
Use smaller plates
Put knife and fork down between mouthfuls
Half the plate should be vegetables or salad
Don’t use food as a reward
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Unhelpful Thinking Styles
Black and white thinking
Catastrophising
Minimising the good things
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Enjoy your food
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Thank you!