Prediabetes

Nearly 79 million people in the US over age 20 have prediabetes. Prediabetes is a condition when the glucose levels are higher than normal but not high enough to indicate diabetes. It is called borderline diabetes. While most people with Pre diabetes do not exhibit symptoms, they are considered to be at high risk of developing heart disease.

In prediabetes, the subtle balance between glucose and insulin is thrown off, as the pancreas are not able to produce enough insulin after a meal to clear the incoming glucose from the blood. Or cells may be insulin resistant so that they do not allow the insulin to escort glucose from the blood stream into them. If you suffer prediabetes,you are at high risk of developing type 2 diabetes. In addition, you may also encounter associated medical problems of diabetes, including heart disease and stroke.

Diagnosis of prediabetes

To determine prediabetes, the doctor performs three different blood tests: Fasting plasma glucose
Oral glucose tolerance test and
Hemoglobin AIC test (Average blood sugar)

Lifestyle changes for prediabetes

Prediabetes should not be ignored as this heralds the process of damage to your heart and other organs such as kidneys, eyes, and nervous system. Losing excess weight can reduce the risk of type 2 diabetes. Even losing 5 to 10% of excess weight can help. Aerobic exercise daily can keep your heart rate up. Eating a balanced diet with low fat protein, vegetables, and whole grains can prevent prediabetes from becoming diabetes.

C reactive Protein Test

C reactive protein is an acute phase reactant produced by the liver as an inflammatory response because of an infection. C reactive protein determination detects the presence of inflammation in the body. C-reactive protein values are very significant in determining the possibilities of long term diseases such as myocardial infarction, neoplastic proliferation and also some inflammatory diseases caused due to infection. C-reactive protein is also considered as the scavenger protein. It binds to many microorganisms in facilitating the process of cell mediated cytotoxicity and also phagocytosis.

C reactive protein test is advised to patients who undergo surgeries pertaining to both general and transplantation categories. It enables in determining the underlying causes of graft rejection. The general CRP determination is of less significance as the values obtained may not describe the underlying health conditions in a specific way. This diagnostic obligation pertaining to the exact values of CRP is eliminated with the introduction of highly sensitive C-reactive protein test (HsCRP).

Principle of the Hs-CRP test

Highly sensitive CRP test is ordered especially in the diagnosis of cardiovascular disease. Hs-CRP test is done using the enzyme linked immunosorbent assay (ELISA). The procedure involves the use of a unique monoclonal antibody which is targeted against a distinct antigenic determinant on the CRP. The CRP molecules in the test sample are sandwiched between the monoclonal antibody which forms the solid phase for immobilization in the test and the enzyme linked antibodies.

Physiology and clinical manifestations

The CRP levels in the body significantly increase after 24 to 48 hours as a response to indicate the onset of tissue damage. These values may remain constant for a longer duration before they reach the normal values. The American Heart Association and the Center for Disease Control have determined the risk groups based on the CRP values. Patients with CRP value less than 1mg/L fall under the low risk groups and values ranging from 1 to 3 mg/L indicate the patients fall under average and high risk groups for cardio vascular disease.

The values of high sensitivity C reactive protein test are part of cardiovascular disease diagnosis. These values are further correlated with other important parameters such as cholesterol levels and glucose levels. Careful analysis is required to understand the history of the patient before the test. This analysis includes a previous history of smoking, infectious disease, alcoholism etc. The hsCRP level values vary if the patient has previously taken non steroidal anti inflammatory drugs. High sensitivity CRP ratios have exceptions in clinical conditions such as arthritis because of the high inflammatory response seen in these conditions. The values are not taken into consideration under these conditions. Coronary artery disease related conditions are predicted in healthy individuals through the hsCRP test.

This Hs CRP test serves as an effective marker in identifying the risk for coronary artery related stroke or heart attack in a healthy individual. The hs-CRP test is also used in the detection of colon cancer and complications related to diabetes and obesity. The hs-CRP test is increasingly becoming an effective test in the pharmacological management of patients by the clinicians as it gives details for the precise use of statins and anti thrombotic medications. Research pertaining to the comparative ratio drawn between patients having high CRP values and low LDL (low density lipoproteins) values prove that these patients are at greater risk of developing cardiovascular disease. These studies conclude that the hs-CRP test is a significant marker in prediction of asymptomatic cardiovascular disease among healthy individuals. The hs-CRP test is also effective in the determination of HNF1A mutations which act as the precursor for the maturity onset diabetes of the young (MODY). This helps in the screening of unidentified diabetes.

Hemoglobin A1c test

Heart disease is a common complication for diabetes patients. For an early assessment of diabetes and also to detect risk of developing heart disease, the American Diabetes Association recommend Hemoglobin A1c test.

High blood glucose (sugar) levels over time can lead to increased deposits of fatty materials on the insides of blood vessel walls. These deposits may affect blood flow, which increases the chance of clogging and hardening of blood vessels and leads to heart disease. Hemoglobin A1c test reflects blood sugar levels. If non-diabetic, the test result would be around 5%. Diabetic persons aim for a score of 7% or lower. However, the health care provider would discuss the most appropriate target that is individual specific.

In general, if the test score is 8% or more, it indicates necessary changes in diet, exercise and medicines in order to manage the glucose levels. Higher A1C level, poorer blood sugar control and higher is the risk of diabetes complications. As the level rises above 6.5%, correspondingly the risks rise.

The Hemoglobin A1c test is a measure of blood sugar control over the past 2 to 3 months. There is a valid reason for specifically measuring it for the last three months. The life of red blood cells (which is measured as part of the test) is three months. By measuring this part, a good indication of the average blood glucose over the previous 2-3 months can be obtained.

The lab test can be done in two ways, a quick finger stick or a sample of blood from vein. Compared to other tests for measuring blood glucose levels, Hemoglobin A1c test is preferred to assist in predicting the risks of coronary heart disease among diabetes.

• Diabetes is a well-known risk factor for cardiovascular disease. The risk increases with A1c levels.
  
  
• Hemoglobin A1C is an important early clinical marker of disease risk.
  
  
• Most doctors consider A1C level the best method to check how well a person is controlling his or her diabetes.
  
  
• Used as a screening test for diabetes, American Diabetes Association has approved the test as a screening tool.
  
  
• Urine tests or daily finger sticks are reliable only for limited period as blood sugar can vary depending on time of day, activity levels, hormone changes etc.
  
  
• Hemoglobin A1C tests measure average blood glucose over the past two to three months. Hemoglobin cells are constantly dying and regenerating. They have a life span of approximately three months.
  
  
• Fasting or any special preparation is not required for Hemoglobin A1c test. This test can be done any time during the day, even after a meal.
  
  
• Measuring and keeping blood sugar close to normal is essential to prevent complications of diabetes.