2/10 Pre-diabetes has many names, often with subtle differences in definition
It's often called:
Impaired glucose tolerence, IGT
Impaired fasting glycaemia
Intermediate hyperglycaemia (preferred by @WHO )
High Risk State of Developing Diabetes (preferred by @AmDiabetesAssn )
3/10 Pre-diabetes is *NOT A DISEASE*
This is really important
It's a *RISK FACTOR* for developing type 2 diabetes
Other risk factors include:
Age >40 (>25 if S Asian)
Family History
Being overweight
People of Asian, African-Caribbean or black African origin, even if born in🇬🇧
4/10 Estimates (see refs) are that 35.3% of adults in 🇬🇧now have pre-diabetes 😲
Similar situation in🇺🇸 where 50% of those >65 have pre-diabetes. That's an estimated 79 million adults in🇺🇸
Projections suggest there will be 472 million people in the 🌍 with pre-diabetes by 2030
5/10 Progression:
5-10% of people with pre-diabetes progress to type 2 diabetes *each year*
@AmDiabetesAssn estimate up to 70% with pre-diabetes will eventually develop type 2 diabetes
👆THIS DOES NOT NEED TO HAPPEN
Some will revert back to normal
6/10 What can be done to prevent progression to type 2 diabetes? There's good evidence that these work:
Dietary change
Exercise
Weight loss (if overweight)
Medications 🤔
7/10 A landmark study from *real world* general practice published in @BMJNutrition offers real #hope
This (my!) #NHS 🇬🇧practice reversed pre-diabetes in *93%* 😲 of those who opted to⬇️ their intake of sugar + starchy carbs aka #LCHF
2/11 The study is by @lowcarbGP@jen_unwin + others and looks at reversing T2DM and pre-diabetes by lifestyle change, in particular by ⬇️sugar and starchy carbs
3/11 The study builds on the work of Prof Roy Taylor's DiRECT Study which found that *severe* calorie restriction could put T2DM into remission👍
More info here 👇 directclinicaltrial.org.uk
This was great news but SO many people find calorie restriction IMPOSSIBLE TO SUSTAIN 🤔🤷♂️
I've spent the last 10 years wondering about this. A TED Talk and paper by @segal_eran (refs at end) has completely blown my mind 🤯
He provides some of the answers - but they may not be what you think
Here goes....
2/11 The incidence of diet-related disease has ⬆️⬆️ in last 30 years
In 🇺🇸 70% of population are overweight, diabetic or have NAFLD (fatty liver)
38% are obese 😲
10% have type 2 diabetes 😲
Diet and lifestyle are the major drivers
3/11 So why don't we know what is the best diet for humans?
It's because we are asking the wrong question
Much of what constitutes the best diet depends on the individual human every bit as much the food
Nutrition needs to be personally tailored to each individual
2/8 I've been prompted to tweet about this after hearing some wonderful news today. A year ago @DrPaulaPowell1 and I assisted at a cardiac arrest on the beautiful but remote Isle of Lewis. David survived and posted a really moving video on FaceBook
2/16
As Diabetes Lead GP at my surgery for 25 years I achieved little/no success with @PHE_uk recommended "Eatwell Plate"
One day @lowcarbGP shared some success he had with offering LCHF (low carb, healthy fat) eating to people with type 2 diabetes
Does it work?🤷♂️
How? 🤷♂️
3/16
Important to understand if there's > 1 teaspoon (5g) sugar/glucose in your blood then insulin PUSHES it into cells where it is deposited as FAT and TRIGLYCERIDE
I’ve been “lent” a #cgm (continuous glucose monitor) so I’m fascinated to see what I can learn over the next 2 wks about how my life affects my sugar
I’m NOT diabetic or pre-diabetic and plan to monitor the impact of different foods and activities @grahamsphillips@Diabetescouk
1st observation is that application of #cgm is painless and adherence to skin is secure
Surprised my ave glucose is 6.3mmol/l
3 x glucose by finger prick finds #cgm over-reads by 0.9-1.5mmol/l (have allowed for 10min delay in #cgm but assumes sticks accurate) 🤔 @DrScottMurray
Effect of exercise: 50min hard interval session running in the pinewoods shoots my glucose up to 9.8 from 5.9 just before I set off. In <1 hour it’s back to 5.9
Conclusion: Exercise puts my sugar up. Surprised at this but @lowcarbGP noticed the same