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84 Pre Diabetes- Beyond The Tip of The Iceberg

India, attributing a greater role to insulin secretory de-
fects in the pathogenesis of type 2 diabetes in Asian
Indians compared with people of other ethnic groups.
The Indian study was conducted on children and
adolescents attending the urban endocrine clinic for
obesity. Robust biochemical evaluation including gly-
cose tolerance tests and HOMA-IR was carried out in
224 obese patients. This cross- sectional data sowed
as increase in the prevalence of IFG (8-10%) IGT (10
to 15%), and diabetes (1.3to 1.8%) from childhood to
adolescent stage, respectively. The increase can also
be attributed to the pubertal spurt of counter reg-
ulatory hormones. Their data also showed positive
association of both systolic and diastolic blood pres-
sure readings with insulin resistance.Studies have re-
corded prediabetes in >10% of Sri Lankan and 20%
in Bangaladeshi adult population. These data raise
questions regarding ethnicity and beta cell reserve.
Parity also has been raised as a possible risk factor
leading to obesity and diabetes in women. The other
observation is that high prevalence of hypertension
and obesity among prediabetics. Studies from the
sub Saharan countries have consistently reported a
higher prevalence of hypertension with rates rang-
ing from 19% in rural Tanzania, 20% in rural Kenya,
21% in rural Nigeria and 32% in urban Namibia. The
situation in the Indian subcontinent is equally worse.
Likewise the prevalence of obesity is high in children
of Africa and India. The associated dyslipidemia and
microalbuminuria in the pre diabetic stage warrant
intervention strategies from care providers.
The good news is that there is an accumulated evi-
dence that this intermediate disorder can be slowed
down or prevented from deteriorating to diabetes
and related pathological consequences. The success-
ful intervention tested were diet and exercise, met-
formin, tolbutamide, orlistat and acarbose. Improved
awareness and diagnosis is possibly the results of
concerted efforts by the Government (through pro-
grammes such as the National Programme for Con-
trol and Prevention of Cancer, Diabetes, Cardiovas-
cular Disease and Strokes) and nongovernmental
organisations. The coordinated effort of Government,
NGOs, Privatesector health care providers with the
focus on the preventable strategies at appropriate
level will be helpful to decelerate this ongoing dys-
glycemic epidemic.

GCDC 2017 & Cardio Diabetes Medicine