I will continue from where I left off last week. There is lot that can be done to prevent or delay diabetes even if one has the risk factors. The World Health Organization (WHO) estimated that 422 million adults were living with diabetes in 2014, compared to 108 million in 1980. The global prevalence of diabetes has nearly doubled since 1980, rising from 4.7% to 8.5% in the adult population. This reflects an increase in associated risk factors such as being overweight or obese.

Over the past decade, diabetes prevalence has risen faster in low- and middle-income countries than in high-income countries. Diabetes caused 1.5 million deaths in 2012. Higher-than-optimal blood glucose caused an additional 2.2 million deaths, by increasing the risks of cardiovascular and other diseases.

Diabetes of all types can lead to complications in many parts of the body and can increase the overall risk of dying prematurely. Possible complications include heart attack, stroke, kidney failure, leg amputation, vision loss and nerve damage. In pregnancy, poorly controlled diabetes increases the risk of fetal death and other complications.Diabetes and its complications bring about substantial economic loss to people with diabetes and their families, and to health systems and national economies through direct medical costs and loss of work and wages.

About 90-95% of diabetes are Type 2 diabetes mellitus. Type 1 diabetes cannot be prevented with current knowledge (American Diabetic Association, Standards of Care 2019). Effective approaches are available to prevent type 2 diabetes and to prevent the complications and premature death that can result from all types of diabetes. These include policies and practices across whole populations and within specific settings (school, home, workplace) that contribute to good health for everyone, regardless of whether they have diabetes. These includes exercising regularly, eating healthily, avoiding smoking, and controlling blood pressure and lipids.

Testing for prediabetes and type 2 diabetes in asymptomatic people should be considered in adults of any age who are overweight or obese (BMI less than or equal to 25 kg/m2 or  greater than or equal to 23 kg/m2) and who have one or more additional risk factors for diabetes (e.g. family history, high cholesterol levels, black, high blood pressure). For all people, testing should begin at age 45 years.If tests are normal, repeat testing carried out at a minimum of 3-year intervals is reasonable. In patients with prediabetes and type 2 diabetes, the primary care provider is to identify and, if appropriate, treat other cardiovascular disease risk factors. Risk-based screening for prediabetes and/or type 2 diabetes should be considered after the onset of puberty or after 10 years of age, whichever occurs earlier, in children and adolescents who are overweight/obese and who have additional risk factors for diabetes.

Diabetes and prediabetes may be screened based on plasma glucose criteria, either the fasting blood glucose (FBG) or the 2-h blood glucose (2-h PG) value during a 75-g oral glucose tolerance test (OGTT), or glycated haemoglobin (HbA1C). Unless there is a clear clinical diagnosis based onovert signs of hyperglycemia (e.g. excessive thirst, frequent urination), diagnosis requires two abnormal test results from the same sample or in two separate test samples.If patients have test results near the margins of the diagnostic threshold, the health care professional should follow the patient closely and repeat the test in 3–6 months.

“Prediabetes” is the term used for individuals whose glucose levels do not meet the criteria for diabetes but are too high to be considered normal (HBA1c 5.7-6.4%, fasting blood glucose 5.6-6.9mmol/L, oral glucose tolerance test 7.8-11.0mmol/L).

Prediabetes should not be viewed as a clinical entity in its own right but rather as an increased risk for diabetes and cardiovascular disease (CVD).Looking at the figures, there is a lot that the primary care provider can do to bring down the burden of diabetes in the community, society and the nation as a whole.

Patients with prediabetes should be given intensive behavioral lifestyle intervention program to achieve and maintain 7% loss of initial body weight and increase moderate-intensity physical activity (such as brisk walking) to at least 150 min/week, dietary therapy.

Several major randomized controlled trials, including the Diabetes Prevention Program (DPP), have demonstrated that an intensive lifestyle intervention can reduce theincidence of type 2 diabetes. In the DPP, diabetes incidence was reduced by 58% over 3 years. Follow-up in the Diabetes Prevention Program Outcomes Study has shown sustained reduction in the rate of conversion to type 2 diabetes of 34% at 10 years and 27% at 15 years. The DPP’s 7% weight loss goal was selected because it was feasible to achieve and maintain and likely to lessen the risk of developing diabetes.

Structured behavioral weight loss therapy, including a reduced calorie meal plan and physical activity, is of paramount importance for those at high risk for developing type 2 diabetes who have overweight or obesity.In this our cocoa noted around the world as of premium quality- a quality standard by which all other cocoa produced are measured against meets the requirements. .

The ADA indicates Metformin therapy for prevention of type 2 diabetes in those with prediabetes, especially for those with BMI greater than or equal to 35 kg/m2 , those aged ˂60 years, and women with prior gestational diabetes mellitus (GDM). Metformin has the strongest evidence base and demonstrated long-term safety as pharmacologic therapy for diabetes prevention.Prediabetes is associated with heightened cardiovascular risk. The ADAadvocates the screening for and treatment of modifiable risk factors for cardiovascular disease (e.g. high blood pressure, high cholesterol levels).People with prediabetes often have other cardiovascular risk factors, including hypertension and dyslipidemia, and are at increased risk for CVD.

Although treatment goals for people with prediabetes are the same as for the general population, increased vigilance is warranted to identify and treat these and other cardiovascular risk factors early.

Looking at implications of prediabetes, there is big role for the early regular/daily consumption of polyphenol-rich cocoa.Cocoa contains significant amounts of fatty acids (oleic acid and stearic of far higher percentage), carbohydrate (low caloric content), protein, vitamins, minerals, fiber, and polyphenols. Cocoa is the richest of polyphenols on weight basis. Polyphenols are notable anti-oxidants. These polyphenols have been found to be highly beneficial in improving insulin secretion by the beta-cells of the pancreas, improving glucose uptake by the cells, improving cells sensitivity to insulin. They have also demonstrated intestinal effects by enhancing signals to the beta cells for insulin secretion in sync with the presence of food in the stomach. Additionally polyphenol  cocoa gives a feeling of fullness after intake in spite of low caloric content, making it easy for the prediabetic and diabetic to adhere to dietary plans.




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