1. Pre-diabetes: Risk Factors & Diagnosis Saoirse Ní Chuirrín DNS Caitriona Lordan Dietitian September 2015

2. 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’.

3. Saoirse Ní Chuirrín Bon Secours Hospital So what’s the difference? 2 different pathophysiological mechanisms! IFG – high after a period of fasting IGT – high post prandial

4. Saoirse Ní Chuirrín Bon Secours Hospital 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%)

5. Saoirse Ní Chuirrín Bon Secours Hospital 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

6. Saoirse Ní Chuirrín Bon Secours Hospital 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!

7. Saoirse Ní Chuirrín Bon Secours Hospital 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.

8. Saoirse Ní Chuirrín Bon Secours Hospital Significance? Indicates an increased future risk of developing Type 2 Diabetes Increased risk of CVD Increased risk of microvascular complications Associated with obesity

9. Saoirse Ní Chuirrín Bon Secours Hospital 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

10. Saoirse Ní Chuirrín Bon Secours Hospital Who to screen? Women who have delivered a baby >9lbs or who have had gestational diabetes Women with polycystic ovary syndrome Previous abnormal result

11. Saoirse Ní Chuirrín Bon Secours Hospital 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

12. Saoirse Ní Chuirrín Bon Secours Hospital 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

13. Saoirse Ní Chuirrín Bon Secours Hospital 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!

14. Saoirse Ní Chuirrín Bon Secours Hospital

15. Caitriona Lordan- Dietician

16. 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

17. Caitriona Lordan Bon Secours Hospital 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

18. 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

19. Caitriona Lordan Bon Secours Hospital Unhelpful Thinking Styles Black and white thinking Catastrophising Minimising the good things

20. Caitriona Lordan Bon Secours Hospital Enjoy your food

21. Saoirse Ní Chuirrín Bon Secours Hospital Thank you!