Study of medical complications in prediabetics

DISCUSSION

The efficacy of detecting people with pre-diabetes in order to avoid T2D has been extensively debated. Clinical trials showing that lifestyle changes and drug-based therapies can prevent or delay T2D progression give some solid evidence .¹³ 

However, detractors claim that only a subgroup of people with pre-diabetes would acquire T2D, and that the population advantages of interventions are exceeded by the possible bad consequences of over-testing, unneeded medicalization, and doubts about the efficacy of preventative techniques outside of the study setting, among other considerations.¹⁴

Different organizations have adopted different criteria for a diagnosis, which have been revised regularly throughout time .¹⁵

Diverse diagnostic criteria identify variable groups of people with different rates of progression to T2D and risk of morbidity, prompting the question of if those that may profit the most from strict clinical treatment are efficiently defined as greater risk by each of the criteria.¹⁶

Pre-diabetes was demonstrated to have a role in the progression of macrovascular dysfunction, which could help to explain why people with pre-diabetes and T2D have a greater risk of cardiovascular disease-morbidity and death.¹⁷

People with pre-diabetes have been documented to have initial phases of retinopathy, neuropathy, and nephropathy, which are often milder types than those observed in established T2D, and preventative studies have shown that their risk can be lowered with lifestyle changes. ¹⁸

This has crucial implications for preventative efforts as well as if glycemic testing and the identification of pre-diabetes in real-world situations influence the progression of microvascular and macrovascular disease in those who go on to acquire T2D .¹⁹

 So this study aim was to study and early discover early complications either microvascular or macrovascular in both patients of prediabetes and medical syndrome.

This case control study included 30 patients with prediabetes (group A), 50 patients with T2DM (group B), and 50 healthy controls (group c). Diabetics and prediabetics had significantly higher mean of age and BMI than control group.

Obesity has long been known as a primary contributor to insulin resistance and T2DM.²⁰

The current study found that diabetic group had the highest mean of FBS, 2hPP and HA1C followed by prediabetic group with statistical significant difference. In terms of 2hPP and HbA1c, post-hoc analysis showed a significant difference between the groups of prediabetics and diabetics.

In agreement with another study in which there is a considerable increase in HbA1c levels with the development of tolerance of normal glucose to prediabetes (IFG and IGT) as well as overt diabetes. When compared to the group having normal glucose tolerance, all groups having altered glucose tolerance—IFG, IGT, and diabetes—had significantly greater HbA1c levels (P\ 0.0001). When compared to newly diagnosed diabetes, both prediabetic states (IFG and IGT) had significantly lower HbA1c; however, the IGT group had significantly higher HbA1c than the IFG group.²¹

In our research, there were highly significant differences in total cholesterol, triglycerides, LDL, and HDL levels amongst the three groups studied. Diabetics had the greatest mean of total cholesterol, triglycerides and LDL level followed by prediatics, while had lowest mean of HDL than other groups followed by prediabetics.

In the Framingham Heart Study, T2DM patients were shown to have lower HDL levels and higher plasma TG levels when compared to non-T2DM patients.²²

Vineetha et al. found statistically significantly lower HDL levels and higher TG levels in people with Parkinson's disease in a case-control study.²³ Lipid profile abnormalities are thought to be a significant risk factor for T2DM in prediabetic individuals.²⁴

In respect of dyslipidemia levels, Bhowmik et al. found findings that were similar to the present research. Their findings revealed a significant link between serum lipid profile and T2DM and Parkinson's disease. Furthermore, the strongest connection with T2DM and PD was shown when high TG levels were combined with low HDL levels. T2DM and PD patients had higher levels of CHOL, TG, and lower levels of HDL.²⁵

In the current study, diabetic group had the highest mean of urea and CRP level followed by prediabetics with statistical significant differences.               

In line with another study that investigated the relationship between blood urea and creatinine levels and blood sugar levels in diabetic and non-diabetic people to see if they might be used to diagnose diabetic nephropathy and compare them to glycemic state. A total of 18 of the 100 diabetic samples exhibited high urea levels. There has been no one with a high urea level in the 100-sample control group. With increasing blood glucose levels, there had been a statistically significant elevation in urea (p<0.05, 95%CI).²⁶

This supports the results of prior research that found hyperglycemia to be one of the leading causes of progressive kidney damage .²⁷

When the kidneys are damaged, a rise in urea levels is observed. Increased blood urea levels in patients with diabetes with high blood glucose levels indicate renal damage. Anjaneyulu et al. discovered that increased urea and serum creatinine levels in diabetic rats suggest gradual kidney damage.²⁸

Another study showed that the levels of CRP can be used as a biomarker in different stages of diabetes .²⁹

Only a few studies have linked elevated CRP levels to prediabetes and diabetes.

According to the findings of the Atalar et al. study, CRP levels were statistically greater in the only dysregulated T2D groups compared to the other groups. The cause of the significantly increased CRP levels in dysregulated diabetics is related to the acute inflammation that occurs as a result of diabetes. Chronic inflammation has long been recognized as a significant risk factor for diabetes-related death .²⁹

CRP levels have been reported to be a valuable biomarker in diabetics for the early detection of chronic processes. Such studies found that high CRP levels were linked to a higher risk of cardiovascular disease in T2D.³⁰

The finding recommends that CRP levels are important in the progression of diabetic patients with chronic inflammation .²⁹

In the current research, the diabetic group had a significantly larger percentage of patients with complications as regarding retinopathy (20% vs 3.3%), neuropathy (32% vs 0%), nephropathy (23.3% vs 0%), hyperlipidemia (56.7% vs 20%) and hypertension (70% vs 30%) than prediabetic group with statistical significant differences.

The prevalence of IGT has been linked with a doubling of cardiovascular death in 44–55-year-old males from the Paris Prospective Study cohort as compared to normoglycemic participants, according to a study.³¹

Moreover, when compared to non-diabetic people, patients who proceed to T2DM have an increased risk of atherosclerotic disorders, leading to an elevated burden of cardiovascular, stroke, and peripheral vascular illnesses.³²

The majority of people with prediabetes show characteristics of the insulin resistance (metabolic) syndrome, such as hypertriglyceridemia, upper-body obesity, lower HDL cholesterol levels, and high blood pressure, among others. The metabolic syndrome components are often discovered in prediabetic people many years prior to T2DM being diagnosed. ³³

Similar to the Gutenberg Health Study in Germany, which found an 8.1% incidence of retinopathy among people with prediabetes.³⁴

In another investigation, microalbuminuria was shown to be prevalent in 15.5% of prediabetic individuals. The retinal hemodynamics and microvascular function of those with prediabetes are also affected. As a result, retinal vasoreactivity tests could be a useful technique for detecting early vascular risk .³⁵

Remarkably, signs and symptoms of classical diabetic peripheral polyneuropathy could develop in pre-diabetic individuals. Peripheral neuropathy affects about 11–25% of people with prediabetes. Additionally, prediabetes is linked to autonomic dysfunction, which manifests as decreased heart rates and a higher incidence of erectile dysfunction.³⁶

CONCLUSION

through complicated molecular mechanisms involving hyperglycemia and insulin resistance, diabetes and prediabetes both predispose people to developing diabetes complications. Whereas intense glycemic control alone will not decrease deaths and major events, a comprehensive strategy that includes lifestyle changes, lowering hyperglycemia, and addressing cardiovascular risk factors linked with diabetes is helpful to those patients' cardiovascular risk profile; thus, blood glucose control targets must be adjusted to the individual patients' needs.