Prediabetes to Diabetes

I came across a new piece of info this morning, in recent a medical journal.
This said that each year between 5% and 10% of those diagnosed as pre-diabetic moved on to develop diabetes.

This would seem to suggest that after 5 years the figure PD>D of the original group would be 25-50%. And after 10 years 50-100%.

Of course this will include many, many people who do absolutely nothing to reverse or even stabilise their condition.

(I will try and track down again, to get the source.)

And here's some stuff from Yudkin (son, not father), on part of the reason he doesn't think 'pre-diabetes' is a useful thing:

"There have been three major trials of diabetes prevention with

intensive lifestyle counselling—in China (n=577),24 Finland

(n=522),25 and the US (the Diabetes Prevention Program,

n=3234).26 All were in people with impaired glucose tolerance

and a mean age around 50 years. Each reported a 40%-60%

relative risk reduction in the incidence of diabetes, with one

case of diabetes being “averted” by treating around seven people

with impaired glucose tolerance for three years.27-29 But the rates

of diabetes during follow-up after the trials imply that the

lifestyle interventions delayed the onset of diabetes by around

two to four years, rather than prevented it altogether."

BMJ 2014;349:g4485 doi: 10.1136/bmj.g4485 (Published 16 July 2014)

And this is Yudkin,(son) again:
"The DPP/DPPOS enrolled high-risk people,

selected because they exhibited impaired

glucose tolerance, and on placebo,

5–10% per year converted to diabetes. By

expanding the category from impaired

glucose tolerance to the looser ADA “prediabetes”

definition, the at-risk population

increases three- to fourfold, but the conversion

rate falls to ;2%per year"
Diabetes Care 2015;38:e81 | DOI: 10.2337/dc14-2910

DPP= Diabetes Prevention Program

Note that this is *US* data, where pre-diabetes is defined by AMA as HbA1c 5.7% or greater. Very different from the 6.0% definition in UK. Therefore, I think you could expect the conversion rate to rise if assuming a UK diagnosis (6.0% or greater). Has anyone done this study in the UK?

Wow! That would be a tough statistic to nail down.
In many respects though perhaps it is 'irrelevant' - not in the way that it doesn't matter, but if you consider that when an individual is diagnosed as pre-diabetic, then it suggests that they have a pre-disposition to developing diabetes. If they then choose to change their lifestyle they will minimise developing diabetes to the point where theoretically it will never develop (so totally low carb for example, keeping excess weight off, leading a healthy active lifestyle etc). (NB - this is only relevant for T2D of course)
Statistics like this is useful to compare something that the individual has little to no control over - such as 'percentage survival rate after boob job' or the like.
Tracking down a statistic of pre-diabetic to diabetic though is a bit slippery and it's likely to be a depressing figure. It makes me think of another thread on this forum where someone complains that they hate to hear 'horror stories' around diabetes - and I can understand why.
The important thing to remember is that you can take control of this condition - just don't let it take control of you. Manage blood glucose levels well through diet and exercise and you will be the one bucking the trend as far as those stats go.

CheeseJunkie said:

And here's some stuff from Yudkin (son, not father), on part of the reason he doesn't think 'pre-diabetes' is a useful thing:

"There have been three major trials of diabetes prevention with

intensive lifestyle counselling—in China (n=577),24 Finland

(n=522),25 and the US (the Diabetes Prevention Program,

n=3234).26 All were in people with impaired glucose tolerance

and a mean age around 50 years. Each reported a 40%-60%

relative risk reduction in the incidence of diabetes, with one

case of diabetes being “averted” by treating around seven people

with impaired glucose tolerance for three years.27-29 But the rates

of diabetes during follow-up after the trials imply that the

lifestyle interventions delayed the onset of diabetes by around

two to four years, rather than prevented it altogether."

BMJ 2014;349:g4485 doi: 10.1136/bmj.g4485 (Published 16 July 2014)

Click to expand...

Nice find!
I wonder what the 'intensive lifestyle coaching' involved? - so what dietary advice was given?

Is there somewhere on the forum where we can post journal research? (I know there is a research section, but this seems to be only about upcoming research project participation (??)

I would be interested in the basis for diagnosis, as well.

I am T2 diabetic but am managing to keep my HbA1c (just) in the pre-diabetic range.
So if I had started this regime as a pre-diabetic then would I still be counted as pre-diabetic?

I think that for a correct diagnosis you would have to include a fasting glucose tolerance test because that checks how your body deals with glucose, not how it responds to long term diet, exercise and medication.

Since it's almost guaranteed that none of the "intensive lifestyle interventions" included a low carb diet, I'd find it difficult to trust the accuracy of any of those stats.

I have no doubt that without my very strict dietary control I would have gone on to full blown diabetes. When I looked at my blood tests over the years each test showed a gradual increase in my fasting blood glucose. If plotted on a graph would show a gradual but steady increase with age.

My friend had a pre diabetic blood test but didn't lose weight, which he does need too, just cut down on sweet stuff but not carbs and had now perfectly normal readings.

So I think that some people have a genetic predisposition to diabetes which means that pre diabetics need to take very strong steps to avoid developing diabetes. Other people have no genetic dispostion and can avoid diabetes with slight dietary changes.

Only my random thoughts though!!

Would be interesting to know the statistics of those T2Ds who, having got themselves into prediabetic ranges through diet and exercise sustained for many years, then went on to lapse into T2D.
I know a GP who believes it is inevitable. Love to show some contrary evidence.

Diabetes is by no means inevitable in my opinion. it is a reversible condition if you stick to the right diet (low carb). Problem is that many of us struggle to do this forever. the food environment is setting us all on a path to diabetes whether we are diagnosed as Pre or not.
Jason Fung website shows how to reverse. he says he has over 90% success rate. Not sure about long term though.

My experience is that i lost weight doing low carb and stayed well for one year by not eating sugar or most carbs. After one year I relapsed and my symptoms went rapidly downhill. 2 stone 2 years and many symptoms later I am worse than before. Reversible yes, but curable no.

You simply have to stick to the diet. I am hopefully back on track because i need to feel better.