Glucose-based targets may ‘change treatment’ for those with prediabetes

Prediabetes indicates that blood glucose levels are higher than usual.

Glucose-based targets may ‘change treatment’ for those with prediabetes
A study suggests glucose targets could be the way forward (Picture: Getty)

A new study has revealed how enhancing insulin sensitivity through lifestyle changes can stop pre-diabetes from turning into type 2 diabetes.

Scientists at the German Centre for Diabetes Research (DZD) analysed how and why people with prediabetes can enter remission, allowing their blood glucose levels to return to normal and experiencing decreased risk of developing type 2 diabetes, and kidney and vascular issues.

Also known as borderline diabetes, prediabetes indicates that blood glucose levels are higher than usual – but not high enough to be diagnosed with type 2 diabetes, a condition that occurs when the pancreas is unable to produce enough insulin to sufficiently regulate blood glucose levels.

Importantly, there is currently no drug therapy used to treat prediabetes – but type 2 diabetes can be treated with a medicine called metformin, or with insulin if treatment is not helping to keep blood glucose levels lower enough, if you have heart problems or if you need to lose weight.

As part of the trial, 1,105 participants with prediabetes were placed on a healthy diet and increased their physical activity.

Insulin sensitivity

After just one year, 298 participants lost at least 4% of their weight – but researchers determined that it wasn’t weight loss that determined whether people entered remission or not.

Interestingly, it was insulin sensitivity. This is how responsive the cells are to insulin, with someone who is insulin sensitive requiring smaller doses of insulin to lower blood glucose levels.

Between the responders (those who entered remission as their fasting blood glucose returned to normal) and non-responders (those who still had prediabetes), there was no difference related to weight loss.

However, the study recommended that reducing waist circumference by 4cm in women and 7cm in men increased the probability of remission.

Overall, the responders experienced an improvement in their insulin sensitivity.

Though prediabetes is currently treated using weight loss and lifestyle improvement, it does not involve glucose-based targets – something which the new study suggests has the potential to ‘change treatment and practice and minimise the complication rate for our patients’, Professor Dr Reiner Jumpertz-von Schwartzenberg, co-first author of the DZD’s study, said.

According to Diabetes UK, more than 4.3 million people in the UK live with some form of diabetes, of which 8% live with type 1 and approximately 90% with type 2.

Critically, 850,000 people could be living with undiagnosed diabetes – and 13.6 million people are at increased risk of type 2 diabetes.

However, type 2 diabetes is not to be confused with type 1 diabetes – an autoimmune condition that occurs when the immune system mistakenly attacks the beta cells in the pancreas. As a result, it stops producing insulin, and so blood glucose levels begin to rise.

Unrelated to diet and lifestyle, it has been linked to genetics and cannot currently be cured.

Those living with type 1 diabetes must inject insulin – either with an insulin pen or an insulin pump attached to the body – and closely monitor their blood glucose levels using a finger-prick test or, increasingly, a continuous glucose monitor (CGM) worn on the arm that can be scanned with a smartphone.

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