Obesity, the technical word for being ‘fat’ is defined as a BMI of 25 or more for people of Indian subcontinent and it increase not only your chance of prediabetes, diabetes and metabolic syndrome but also death from all causes (health risks of obesity)

What is common among all of these conditions is the phenomenon of ‘insulin resistance’ in which the carbohydrate and fat metabolism mechanisms in the body are deranged

Insulin is a hormone made in the pancreas, an organ located behind the stomach. Insulin plays a major role in metabolism—the way the body uses digested food for energy. With the help of insulin, cells throughout the body absorb glucose and use it for energy

Insulin resistance is a metabolic disorder in which the body produces insulin but does not use it effectively. When people have insulin resistance, glucose builds up in the blood instead of being absorbed by the cells, leading to type 2 diabetes or prediabetes

Metabolic syndrome, also called insulin resistance syndrome, is a group of traits and medical conditions linked to overweight and obesity that puts people at risk for both cardiovascular diseases (CVD) and type 2 diabetes

People with metabolic syndrome

• Have a fivefold greater risk of developing type 2 diabetes
• Are twice as likely to die from, and three times as likely to have a heart attack or stroke compared with people without the syndrome

So, how do you get to know whether you have prediabetes, metabolic syndrome or diabetes?

Tests for prediabetes and diabetes:

The gold standard test to diagnose these conditions is Fasting Blood Glucose( FBG) 

Fasting blood value of <110 mg/dL as defined by WHO (or <100 as defined by ADA/AACE) is  normal.

A Fasting Blood Glucose (FBG) value of 126 mg/dL or more is diagnostic of diabetes, although a repeat FBG or HbA1c test is needed to confirm this diagnosis

IFG (Impaired Fasting Glucose) type of prediabetes

But if your FBG lies between 110 and 125 (or 100 and 125 as per ADA), you, most likely, have IFG/ prediabetes. To confirm that you have prediabetes, you need to have one of the two additional tests: Oral Glucose Tolerance Test (OGTT) or HbA1c

IGT (Impaired Glucose Tolerance) type of prediabetes

If your 2 hour blood glucose level in OGTT (with ingestion of 75gm load of sugar) is between 140 and 199 mg/dL, you have IGT (Impaired glucose Tolerance) type of  prediabetes, if it is more than 200, you have diabetes. If however, this level is lower than 140 mg/dl, you have IFG (Impaired Fasting Glucose)

The risk of a person with IGT getting diabetes is six times higher and with both IFG and IGT is 12 times higher  than a person with normal levels

Glycosylated hemoglobin or HbA1c

HbA1c can also be used for screening for diabetes or prediabetes. But to confirm the diagnosis blood sugar levels FBG and PP (Post Prandial/post meal) Blood Sugar are needed. Also, in certain conditions use of HbA1c may not be warranted (To know more: go to: ‘HbA1c in diagnosis and management of diabetes‘)

HbA1c level of 6.5% or more is diagnostic of diabetes, HbA1c less than 6% (or 5.7% as per ADA) is considered normal, whereas values between 6 and 6.5% are suggestive of prediabetes

Metabolic syndrome

Metabolic syndrome is defined for Indians as the presence of any three of the following:

• Large waist size—waist measurement of 90 cms or more for men and 80 cms or more for women
• High triglycerides in the blood—triglyceride level of 150 milligrams per deciliter (mg/dL) or above, or taking medication for elevated triglyceride level
• Abnormal levels of cholesterol in the blood—HDL cholesterol level below 40 mg/dL for men and below 50 mg/dL for women
• High blood pressure—blood pressure level of 130/85 or above, or taking medication for elevated blood pressure
• Higher than normal blood glucose levels—fasting blood glucose level of 100 mg/dL or above, or taking medication for elevated blood glucose

So, what should you do if you get diagnosed with prediabetes or metabolic syndrome: the answer is lifestyle modification for prediabetes management

CHECK OUT: Our references for recommendations on weight management