OFTEN when we hear the word “borderline” we may make a mental note that certain things need to change, but perhaps rarely do we lie awake worrying about these “borderline results”.

Two of the most common borderline results are blood pressure readings and blood sugar levels. While there isn’t a specific term for borderline blood pressure, pre-diabetes is a recognised condition in which blood sugars are above the norm, yet not high enough to constitute actual diabetes.

The complications of established diabetes are well documented, with a two-fold increased risk of stroke and a two and half times greater risk of heart attack compared to those with normal sugar levels. Cognitive decline, vascular dementia and Alzheimer’s disease, as well as sight loss, kidney disease and limb amputation add to the dizzying array of life changing sequelae of raised sugars damaging blood vessels throughout the body.

Unsurprisingly those with established diabetes have suffered worse than unaffected individuals in the current pandemic. Persons with the condition are more likely to develop severe Covid infection, to need admission to hospital and require escalation to an intensive care unit (ICU). Death rates for those admitted to hospital are twice as high for those with type 2 diabetes, and an even greater 3.5 times that of those without the condition, for those with type 1 diabetes.

While type 1 diabetes cannot be prevented, type 2 diabetes, often labelled a “lifestyle disease”, is commonly marked by a latent period of borderline raised sugar levels. This pre-diabetic state may last several years, during which damage is being done to both large and small blood vessels.

Pre diabetes arises due to decreased insulin manufacture and the body’s relative insensitivity to that produced. As a compensatory mechanism, the pancreas tries to produce more insulin and the liver gets rid of less in the circulation. Unfortunately, the pancreas can’t keep up forever and at some point, sugar levels rise to those sufficient to formally diagnose type 2 diabetes. Between 5-10per cent of those with pre-diabetes develop type 2 diabetes within 12 months, although the phase can last a decade.

Importantly, while undiagnosed diabetes has many symptoms to alert the sufferer that something is not right, pre-diabetes is notoriously without any indicators.

Recent British research has shown that those with pre-diabetes are at risk of cognitive decline. The study, looking at half a million individuals, showed a 42per cent increased risk of mental decline over four years and over twice the risk of actual vascular dementia over eight years, compared to their counterparts with normal blood sugars. This is sobering news for a condition the sufferer may be blissfully unaware of.

This also raises the question, is pre-diabetes a risk factor for worse outcome if infected with Covid-19? The answer is not clear at this point. Various theories have been put forward, including borderline raised sugars being a risk factor the same as actual type 2 diabetes, through to Covid-19 precipitating the onset of both type 1 and type 2 diabetes. One study of hospital inpatients with Covid-19 indicated that almost a quarter had impaired blood sugar control. It is important to note that these are observational studies and cause and effect has not yet been proven.

What we do know that is that pre-diabetes, if diagnosed, can also be viewed as golden opportunity to push sugars back in to the normal range, rather than let them rise to the levels of type 2 diabetes.

Authorities on the subject advise that three in five cases of type 2 diabetes can be prevented by lifestyle measures. As one of the most prevalent non-communicable diseases (NCDs), that represents a significant number of individuals who could avoid a diagnosis.

I’m sure the majority have heard the adage “less in, more out”, and a reduced calorie intake together with an increased level of physical exercise is certainly one of the ways of addressing the situation. Yet raised sugars can also be caused by mental turmoil. Even one sleepless night is enough to affect your glucose (sugar) metabolism, so it really is a case of a healthy mind in a healthy body.

Although routine services have undoubtedly been disrupted by the pandemic, I would always urge people not to wait until the pandemic is over, to feel that they are a burden on the service, or to worry that by entering medical facilities, they are more likely to catch Covid.

Prevention is always better than cure and it is vital that we address serious conditions sooner rather than later.

* Useful websites: diabetes.org.uk, diabates.co.uk, nhs.uk/conditions/diabetes