The Effect of Lifestyle Modification on the Risk of Prediabetes Among Patients Attending Outpatient Clinic of Research Institute of Medical Entomology.

Diabetes is a worldwide epidemic and Type 2 DM (T2DM) accounts for nearly 90% of all diabetes cases worldwide. In Egypt, the prevalence of DM among adults was reported to be 15.2%. Recently it was estimated that 10.9 million had diabetes and this number is expected to rise to 13 million by 2030. This makes Egypt rank in the 10th position among countries with highest prevalence of DM. Furthermore, reports indicate that 43% of patients with diabetes and most patients with prediabetes in Egypt are likely undiagnosed.

Type 2 diabetes, which makes up the bulk of diabetes cases, is largely preventable and, in some cases, potentially reversible if identified and managed early in the disease course. IT doesn't usually appear all of a sudden; many people have a long, slow, invisible lead-in to it called prediabetes. Prediabetes precedes T2DM, and in most of the cases, it ultimately leads to the development of diabetes.

There are no clear symptoms of prediabetes; Some people with prediabetes may have some of the symptoms of diabetes or even problems from diabetes already. The single sign of prediabetes is elevated blood glucose on a blood test that is not high enough to be classified as type 2 diabetes mellitus. Criteria for diagnosing Prediabetes are elevated Glycated hemoglobin (Hba1C), impaired fasting plasma glucose (IFPG), impaired glucose tolerance (IGT), and both IFPG together with IGT. Cutoff levels indicating prediabetes are Hba1c of 5.7-6.4%, Fasting blood glucose of 100-125 mg/dL and 2-hour Oral Glucose Tolerance Test (OGTT) of 140-199 mg/dL. The 2-hour OGTT is laborious to perform, and results are inconsistent. FPG is commonly used in both clinical and epidemiological studies, but patients need to fast overnight. HbA1c detection is more convenient, more accurate with less pre-analytical and analytical variability; its use to diagnose diabetes has been widely recommended.

The prevalence of prediabetes is high and is increasing rapidly in all parts of the world. It was reported to affect 1 in 3 adults in the US and approximately 720 million individuals worldwide. In Egypt, the prevalence of prediabetes in a community-based sample was found to be 21.7%. In a convenience sample of 352 employees at Faculty of Medicine, Ain Shams University, 36% were at high risk and 65.4% of high-risk participants were confirmed to be Prediabetic (23.6% of total sample). It was slightly lower among adults attending PHC in Al Bahah city, KSA (20%, around 21% in males and 19% in females of all ages).

The main risk factors that strongly influence abnormal glycemic level are age, being physically inactive, previous history of abnormal glycemic level and waist circumference. Other factors include aging, smoking, obesity (central obesity), hypertension, and a family history of DM . Prediabetes is associated with increased risk of diabetes, cardiovascular events, and mortality. Approximately 10% of people with prediabetes progress to having diabetes each year. The progression of prediabetes to overt T2DM is around 25% within 3 to 5 years and as many as 70% of them will be manifested with diabetes within their lifetime. Therefore, identifying those individuals with prediabetes is crucial and cost-effective for reducing the incidence of diabetes.