Diabetes Prevention for Thailand

Abstract

Prevalence of diabetes mellitus in Thailand progressively rises more than doubling in the past 20 years. Early detection in people at risk is a crucial measure to reduce burden of the disease. Prediabetes, characterized by hyperglycaemia below the threshold level to define diabetes, is a high risk to develop diabetes and cardio-metabolic disorders. Regarding to previous evidence, the incidence of progressing to diabetes is approximately 5-20% per year depending on clinical characteristics and glycaemic parameters. Risk estimation and appropriated screening system for detecting the people both at risk and with newly diagnosed diabetes, may be done in two-step approaches. First, diabetes risk is estimated by Thai Diabetes risk score or by diabetes risk factor or by “metabolic syndrome” evaluation. The next step is using glycaemic parameter evaluations, of which each parameter has some advantages and some limitations regarding diagnosis or prediction of prediabetes and diabetes. In the context of Thailand, we propose using Thai Diabetes Risk score initially and then further screening with fasting plasma glucose (FPG). The next step is providing 75-gram oral glucose tolerance in some people with high FPG range (≥110 mg/dL) which can identify people in a very high risk group and newly diagnosed diabetes. After categorization, appropriated lifestyle intervention should be the mainstay measure to prevent diabetes, and reduce the burden at national level.