Different Strategies for Prediabetes Management
by Niala Orodi
July 3, 2019
Prediabetes is an intermediate state of high blood sugar level (hyperglycemia) in which the glucose level is above the normal level but below the diabetes diagnostic levels. It is a critical metabolic state, and individuals with prediabetes have a high probability of developing diabetes. Prediabetes screening is essential in early identification. The prevalence of diabetes can significantly be reduced if appropriate interventions are executed at this stage. Estimating the global burden of prediabetes prevalence is still a challenge due to the complexities of identifying the condition. The prevalence estimate vary widely based on the type of diagnostic criterion used. There is a rapid increase in the prevalence of prediabetes in all parts of the world. Appropriate intervention needs to be taken to stop the trend and avoid progression to a diabetic epidemic. Public health interventions should be prioritized towards prediabetes to decrease the progression to type 2 diabetes (T2D). It has been estimated that 70% of prediabetes cases progress to T2D with is the most prevalent type of diabetes. The risk of diabetes progression can significantly be reduced through lifestyle modification. Diabetes prevention program (DPP) interventions comprise of physical activity, weight loss and dietary changes.
Strategies for managing and preventing diabetes
Effective interventions include diet alone, weight loss, exercise alone, and diet plus exercise. The risk of developing T2D can significantly be reduced by 58% over three or more years through the adoption of structured Diabetes Prevention Program (DPP), intensive program of dietary and exercise counselling in combination to a weight loss regimen. The approach is considered to be more effective than metformin in the reduction of diabetes risk. The protective benefit of the intervention can persist for at least 10 years. It has been demonstrated that diabetes intervention programs can be effective in primary care settings.
There are several strategies that can be effective in reversing prediabetes. They include:
- Engaging in regular physical exercise: Physical activity is critical in lowering blood sugar levels and decreasing body fat.
- Losing weight: Research findings indicate that losing 5% to 7% of body weight can decrease the risk of getting diabetes by 58%.
- Eating better: A healthy meal that is naturally rich in nutrients with low carbohydrates, high fiber, and low-fat content is appropriate. Developing a healthy meal plan helps in controlling blood sugar, managing weight and controlling the risk factors to heart disease.
- Getting enough sleep regularly: Lack of enough sleep on a regular basis makes it difficult for you to lose weight. Sleep shortfall increases the risk of T2D by making it harder for your body to use insulin.
- Getting support: You need people to help and hold you accountable in order to lose weight, eat healthily and exercise regularly.
- Making a choice to commit: You need to make a conscious choice of engaging in daily activities that enhance better health outcomes.
- The last strategy is ensuring that you see a doctor every three to six months. You can get a positive reinforcement if you are doing well or assistance to get back on track in case you are not doing so well.
The role of technology in enhancing adherence to strategies for managing and preventing diabetes
Research findings indicate that technology has the potential of increasing the reach, effectiveness and scalability of behavioural lifestyle interventions. Technology-enhanced interventions have proven superior to usual care due to their significant impact in reducing the progression of diabetes. Electronic Health Records (EHR) provides a means for embedding pre-diabetes goal setting into daily primary care practice. Daily physical activity among pre-diabetes patients can be increased through technology-enhanced goal setting. Careful attention to workflow is critical in the use of technology to improve primary care goal setting. The use of health technologies such as EHR, text messaging, and the internet can assist in improving the behavioural management of diabetes. Devices like pedometers can improve diabetes-related behaviours. Interventions that are critical in sustaining behaviour changes are telephone calls reminders, physical activity prescriptions, and the use of goal-setting.
Although DPP intervention has been found to be effective in reducing the incidence of T2D among adult at high risks by 58%, it is yet to be effectively implemented in primary care. Healthcare providers can play a critical role in the program by encouraging behaviour changes. Lifestyle-based DPP interventions are scalable, exportable, and can have a significant impact on health outcomes. Obesity cases can be reduced and its disease burden lessened through successful adoption of effective lifestyle interventions like DPP. The interventions can employ multiple channels of delivery and targets all population at risk. Appropriate execution of DPP initiative can result in body weight reduction, improved waist circumferences and fasting plasma glucose level. The strategy is more effective than the usual care.
Factors hindering the effective management and prevention of diabetes
There are several patient-related factors such as low self-efficacy, the inappropriate perception of risks, lack of willingness to change, and poor understanding that act as obstacles to a successful implementation of behaviour change programs in primary care. The mixed levels of knowledge of the participants on whether the prevention of diabetes is possible and little knowledge of risk factors have been described as challenges. Lack of patient motivation to change their unhealthy habits is considered to be a critical barrier to effective lifestyle counselling. Diabetes is a disease that can be self-managed. As a result, factors such as financial barriers, social support, attitudes and beliefs about illness, and access to care are considered an essential component in determining the health of individuals. The impediments to behaviour change include pre-existing physical conditions and social demands. A holistic approach to lifestyle intervention is needed to overcome the impediments. Comprehensive lifestyle interventions such as DPP have the time and resources for intervening in behavioural, education and motivational factors. It is critical for interventions led by the primary care provider to be focused and smaller in scope.
The management of prediabetes is critical in reducing the economic burden associated with diabetes. It focuses on normalizing glucose levels and preventing or delaying the progression to diabetes and associated comorbidities. Digital translations of diabetes prevention programs can realize better weight loss outcome in comparison to the usual care. Studies have established that technology-mediated weight loss programs are more effective than conventional approaches. The technology-based intervention range from diet and exercise curricula delivered via text message, internet, videos, and application-based setting and fitness tracking. Digital version of DPP has been developed using a wide range of technologies that include text message support, recorded video lessons, live video-conferencing, and recorded video lessons. Technology-mediated diabetes prevention interventions are effective and can be scaled rapidly with the aim of improving access and lowering the delivery cost.