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   Jun 24

Have you got pre-diabetes? One in three of us is on the brink of full diabetes – which cuts SIX YEARS off your life. And fat or slim, you may be a victim

Britain is facing a type 2 diabetes epidemic of unprecedented proportions

The figures are grim. More than one in three adults has ‘pre-diabetes’ and has no idea they’re at risk, according to research just published in the British Medical Journal.

As a result, Britain is facing a type 2 diabetes epidemic of unprecedented proportions.

Type 2 diabetes, the kind that develops in adulthood and is linked to lifestyle, is not a condition to be dismissed lightly— it can reduce life expectancy and lead to complications such as blindness and amputation that seriously affect quality of life.

Pre-diabetes is a term used to indicate you have raised blood sugar levels and are therefore at greater risk of developing type 2 diabetes in future.

The rapid rise in the numbers said to be affected by pre-diabetes — three times what they were a decade ago — has come as a shock even to medics.

‘This study has taken us all by surprise — it’s been a bit of a health bombshell,’ says Dr Stephen Lawrence, a GP and clinical adviser on diabetes to the Royal College of General Practitioners.

The figures are ‘alarming’, says Simon O’Neill, director of policy at Diabetes UK. ‘It’s worse than we expected.’

It must be acknowledged that some specialists aren’t convinced that pre-diabetes exists.

‘It’s nonsense,’ says Craig Currie, professor of applied pharmacoepidemiology, Institute of Primary Care and Public Health at Cardiff University.

‘Either you have type 2 diabetes or you don’t have type 2 diabetes. I think this is simply a scare tactic to make people take notice.’

However, the consensus is that raised blood sugar levels, whether they’re labelled pre-diabetes or not, are not healthy.

So, how can you tell if you are at risk — and what can you do to protect yourself? We talked to the experts…


There are no symptoms — pre-diabetes just means your blood sugar levels are at the very high end of the normal range, but not quite high enough for a diagnosis of type 2 diabetes.

In Britain, it is measured using a test called HbA1C — if your blood sugar is between 6 to 6.4 per cent, this is called pre-diabetes (6.5 is officially diabetes).

High blood sugar is a tell-tale sign that your body is producing the hormone insulin, but is no longer able to use it effectively — known as insulin resistance.

Insulin mops up excess sugar from the blood and takes it to the cells to use for energy. But when your body becomes insulin resistant, sugar starts to build up in the blood, causing damage to blood vessels and nerves.

The closer your blood sugar readings are to 6.5, the more likely you will start to develop complications because of high blood sugar levels, says Melanie Davies, professor of diabetes medicine at Cardiff University.

‘This is the point where the first complications begin, in particular problems with changes to cells at the back of the eye, known as retinopathy, which can lead to blindness.’

Symptoms include blurred vision, floaters and sudden vision loss.


Find out how Type 2 diabetes develops

There are some studies that suggest eating too much sugar could be to blame, but the evidence is not yet strong enough to say for sure, says Mr O’Neill.

In fact, the major risk factor for pre-diabetes is having a BMI of 25 and above, especially if you tend to be ‘apple shaped’ and carry fat round your waist.

‘We believe anything that makes you put on excess weight is the problem — whatever you are eating,’ says Mr O’Neill.

This is because fat sits close to the vital organs, including the pancreas, which reduces its ability to produce insulin.

Another risk factor is age — from 40 your risk steadily starts to increase.

As we age, the mitochondria — the tiny powerhouses — in our muscle cells start to slow; this increases the fat content in the cells, leading to insulin resistance.

Ethnic origin is another risk factor.

‘People of South Asian origin are up to six times more likely to develop pre- diabetes as a genetic susceptibility means they start to develop insulin resistance at a much lower BMI,’ says Mr O’Neill. Black and other ethnic minorities are also at increased risk.


though weight plays an important role in who might develop pre-diabetes, not all people with the condition are overweight.

Even if you are thin, you could still develop pre-diabetes, says Douglas Twenefour, a specialist diabetes and obesity dietitian at Central London Community Healthcare NHS Trust and a spokesman for Diabetes UK.

As he explains: ‘You may have a family history of type 2 diabetes or polycystic ovarian syndrome — a hormonal disorder where multiple cysts grow on the ovaries — which raises your risk of type 2 diabetes, regardless of your weight.’

If a woman has given birth to a baby who weighs more than 10 lb, she may also be at greater risk of developing pre-diabetes — it’s thought that women who have heavier babies tend to be heavier themselves.


If you think you might have pre-diabetes, you could start by taking a risk assessment test — the easiest way to do this is online at diabetes.org.uk/risk.

Another option is to ask your pharmacist to do the risk assessment for you.

Note, this is not a blood test, but based on your answers, it will show if you should go to your GP to request for further assessment, which may include a blood test.

If you are over 40 and live in England, you can ask for a blood test at your local GP surgery as part of the NHS Health Check, says Mr Twenefour.

‘If you are under 40, you will need to have some justification for your request, for example, because a close family member had the disease,’ he says.

The NHS Health Check is a five-year check that’s meant to be offered to everyone aged between 40 and 74.

It aims to assess people for a range of health problems, including pre-diabetes and diabetes — however, less than half the people who should have been offered the checks have been.

In any event, GP Dr Lawrence suggests that people who are 40 or older and have a BMI above 25 should be checked for pre-diabetes, as should those with a close relative — parent or sibling — who already has type 2 diabetes.

In the past, doctors used one of two blood tests to check for blood sugar levels.

The fasting plasma glucose test showed how much glucose was in the blood after fasting for at least eight hours.

Meanwhile, the oral glucose tolerance test showed how much glucose remained in the blood two hours after eating sugary foods.

These tests do provide a snapshot of someone’s blood sugar levels at a given time.

However, a newer test, known as HbA1C, is now being done universally.

This doesn’t involve fasting and provides a picture of your blood sugar levels over the past two to three months.

It counts the number of glucose molecules stuck to the red blood cells, which reveals how much sugar you have carried in your blood over the two to three month lifespan of the red blood cell. Doctors then average that out.

‘The greater the number of glucose molecules sticking to red blood cells, the higher the risk of develop-ing type 2 diabetes,’ says Professor Davies.

‘The advantage is that you don’t need to fast for eight hours before having the test or wait around in the surgery for two hours after you eat sugar, which is the length of time it takes to metabolise sugars in the blood.’


Type 1 diabetes is an auto-immune disorder that is normally present from childhood and occurs when the body cannot produce its own insulin.

Pre-diabetes cannot lead to type 1, but can lead to type 2, which is linked to lifestyle and being overweight.


‘People who take in too many calories, in whatever form, put themselves at risk of pre-diabetes,’ says Mr Twenefour.

‘If you are drinking lots of sweet fizzy drinks and fruit juice, and you cut that out, it is going to help, but not specifically because they are comprised of sugar.

‘The key thing is that you lose weight, whether you cut out sugar, protein or fat.’

You can also reverse pre-diabetes by eating a healthy, balanced diet, increasing your intake of fibre and doing more exercise.

According to Professor Davies, even walking around a little more can make a big difference.

‘If people increase their daily step count by 2,000 steps, in two to three years they can halve their risk of developing diabetes.’


People think it’s just type 1 diabetes that’s serious because you need insulin injections, but it’s wrong to think type 2 is nothing to worry about, says Simon O’Neill of Diabetes UK.

‘The average reduction in life expectancy from type 2 diabetes has gone down from ten years to six, but losing six years of your life is still a lot if you are diagnosed with type 2 at 65.’

Adults with diabetes are at high risk for heart disease or stroke.

Some with type 2 diabetes will also end up having an amputation, usually due to neuropathy or nerve damage – every year in England alone there are 12,000 lower leg amputations through diabetes.

‘Patients lose sensation and don’t notice when they damage their limbs. Because diabetes can affect circulation, tissue repair takes longer,’ explains dietitian Douglas Twenefour.

Another complication is blindness, due to diabetic retinopathy, when blood vessels at the back of the eye begin to bulge and leak blood.

Diabetics are 20 times more likely to develop retinopathy than the rest of the population, but symptoms may not show until the condition is advanced.


Diane Clixby, 48, was diagnosed with pre-diabetes four years ago. A council manager, she lives near Hull with her husband Andrew, 49, a groundsman. They have two daughters, Amanda, 26, and Stephanie, 22. Diane says:

‘Now I watch my diet and regularly use the treadmill at home,’ said Diane Clixby

Diabetes frightens me because I’ve seen the complications it can cause.

My daughter Amanda has type 1 and has nerve damage to her legs. She has her eyes checked regularly for damage.

My brother has type 2 diabetes and also has eye damage.

Four years ago I weighed 14st 4lb — at 5ft 2in, I was officially obese. A blood test at a routine check-up showed I was pre-diabetic, but the nurse didn’t tell me.

As it happened, I decided to lose weight because I’m a special constable and my uniform had become so tight I had to wear men’s trousers, which was degrading.

That year I lost 3st by cutting down on sugary foods and eating more veg and fruit.

When I went for my annual check–up I was told that 12 months before I’d been borderline diabetic, but was now in the normal range again.

I was really annoyed no one had told me, as with my family history I would have made it even more of a priority to get my weight down.

Now I watch my diet and regularly use the treadmill at home.

My blood sugar is going to be something I’ll keep my eye on for the rest of my life.


Ketan Shah, 46, was diagnosed with pre-diabetes three years ago. A housing officer, he lives in Leicester with his wife and two children. He says:

For a few months I’d felt something was wrong. I was tired all the time and had no energy.

I’d come home from work and just sit down — in the past, I’d have done things with the children and helped cook dinner.

My wife urged me to see a doctor. When he said I had pre-diabetes and could be heading for full-blown diabetes I was really worried.

I knew I wasn’t in great shape — my weight had crept up from 12 to 13½ stone and I’m only 5ft 3in, giving me a BMI of 33; my waist was 40 in.

I had an office job and could get through at least one chocolate bar and a packet of crisps each day. Apart from the weight, I didn’t realise that being of Asian origin put me at higher risk of diabetes, too. After my diagnosis I went on a six-week course arranged through my GP to learn about diet.

It’s no good trying to change everything overnight, it’s better to make small changes over a longer time, reducing sugary snacks rather than banning them.

I stopped having 2 tsp sugar in my tea, cut back on snacks and instead of rice and bread with my main meal I’d just have one, because they’re high in carbohydrate, which converts to sugar in the blood. I started eating more fruit and vegetables and slowly lost half a stone.

Now instead of working through lunch at my desk I’ll take a 30-minute walk. I also set up a weekly walking club.

My blood sugar is now in the normal range and my waist is down to 37in. I’m doing all I can to make sure I don’t get diabetes.


Douglas Nichol, 70, developed pre-diabetes eight years ago. A retired university careers adviser, he lives in Leicester with his wife Mary, 66. The couple have three grown-up children. Douglas says:

I’d always been thin and had no idea that I was on the verge of diabetes. I only found out after volunteering for a research screening programme.

A blood test showed my blood sugar was high and the doctor explained that though I didn’t have diabetes, I was heading that way.

I was surprised. I weighed 14st 12lb — at just under 6ft tall, my BMI was 29, so I was overweight, though not by much.

The news made me panicky — I’d had a mild heart attack at 58 and knew that diabetes greatly increases your risk of heart disease and stroke.

I really didn’t want to get full-blown diabetes, so though I was already playing golf twice a week, I started taking a brisk 45-minute power walk every day, too.

I stopped eating bread and cut down on potatoes; I also started eating more vegetables.

My one indulgence is a couple of glasses of red wine every night. I’m now a healthy 12st 5lb and my blood sugar level is in the normal range.


Your large glass of wine or pint of beer is reducing your diabetes risk by up to 58 per cent
Losing is weight the single best way for reversing pre-diabetes.

As Paul McArdle, a specialist diabetes dietitian, explains: ‘If you are able to lose just 5 per cent of your weight (that’s half a stone if you weigh 12st), and keep the weight off for four years, you can reduce your risk of it turning into diabetes by 58 per cent.’

Shed 15 per cent and you reduce your risk by as much as 90 per cent. Increasing your physical activity — even if you don’t lose weight in the process — can reduce the risk of diabetes by 44 per cent, because it improves blood glucose control and insulin action.

When it comes to diet, certain foods may be beneficial for warding off the disease.

Green leafy veg

Just one serving (2 tbsp) of vegetables such as spinach, kale, broccoli and Romaine lettuce every day is enough to reduce your risk of developing diabetes by 14 per cent.

Increase that to one-and-a-half servings and studies show you can double that reduction to 30 per cent.

Green vegetables are a rich source of magnesium, which appears to offer some kind of protection against diabetes. Raised blood sugar levels are linked to magnesium loss.

Paul McArdle recommends that pre-diabetics aim for seven to ten portions of fruit and vegetables, with the emphasis on vegetables.


The high calcium content in dairy products is thought to improve insulin levels. The probiotic bacteria in yogurt may also help with blood sugar levels.

Be sure to choose foods with 10 per cent sugar or less.


Despite their high fat and calorie content, regular consumption of nuts seems to aid weight control — possibly because nuts help you feel full for longer.

A U.S. study of 140,000 women found that those who ate a 28g packet of walnuts twice a week for eight weeks were 24 per cent less likely to develop type 2 diabetes than those who rarely or never ate them.


Studies consistently show that three daily servings (one serving is a slice of wholemeal bread, a bowl of cereal, 2 tbsp cooked brown rice or pasta) of wholegrains reduces your risk by 31 per cent.

Plant compounds called isoflavones in wholegrains may also help — they’ve been shown to lower blood glucose levels.

Paul McArdle advises avoiding potatoes because they have a high glycaemic index, which means the sugars are quickly absorbed into the blood.


Experts believe it might be the phytochemicals in coffee rather than the caffeine that helps.

A large U.S. study published in 2006 found that four or more cups a day reduced risk by 47 per cent.


Studies have shown that too much alcohol (more than five units a day) and no alcohol at all increase your risk of diabetes.

But you can enjoy two to three units a day, safe in the knowledge that your large glass of wine or pint of beer is reducing your diabetes risk by up to 58 per cent, according to a 2009 study by Canadian researchers published in the journal Diabetes Care.

It’s thought just the right amount of alcohol may help improve the ability of your cells to react to insulin.

Blueberries, grapes and apples

Fruit isn’t usually recommended for borderline diabetics because of its high levels of sugar, but studies on blueberries, grapes and apples found them to aid blood sugar control.

They have high levels of compounds shown to enhance glucose uptake in mice, which could prevent pre-diabetes turning into the fully fledged condition.

Blueberries, for instance, appear to cut risk by 26 per cent compared with 2 per cent for other fruit.

Fish and olive oil

Mediterranean-style diets containing more olive oil and oily fish such as salmon, sardines and mackerel have been linked to a 40 per cent lower incidence of diabetes.

But keep an eye on your calorie intake to avoid weight gain.


White meat is a far better option than red meat, which can increase your risk of type 2 diabetes by 20 per cent for every daily serving.

It’s also significantly better for you than processed red meat such as sausages, burgers and bacon.

If you eat more than five servings of processed meat a week you have a 46 per cent increased risk, which goes up 19 per cent with every additional serving per week.

Source: Daily Mail

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