Guidelines for integrated early diagnosis, prognosis, follow-up and prevention/Pre-diabetes

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Seafarers and prediabetes

The man went to sea in ancient times in search of great conquests, chasing precious treasures, out of curiosity, forced by lack of food and many other possible reasons, however the requirements arising from the conditions of navigation, hard work on board, malnutrition and diseases such as scurvy health of these ancient mariners who also witnessed major epidemics that affected the world through the ports of the time seriously affected. Today seafarers continues faced great challenges to protect the integrity of your health, particular hazards of maritime work, looking exposed to conditions and difficult tasks in which physical fitness is a fundamental pillar.

This physical condition required is assessed in compliance with International Standards such as STCW78 / 95 Amended and The Maritime Labour Convention which require a compulsory presentation of a valid certified by a doctor, qualified, experienced and duly authorized by the Maritime Authority ; to specify whether or not meet the medical requirements for the performance on board. In medical examinations it is important an adequate clinical history, the necessary paraclinical justified with the primary goal of early diagnosis of diseases that may be exacerbated by the maritime labor and detection of modifiable risk factors to prevent the development of diseases that undermine the health of people sea.

A clinical condition that deserves compulsory care in medical examinations of seafarers because of their importance are the changes in blood glucose levels that do not correspond with diabetes but neither is considered normal, this intermediate stage of metabolic relevance today called PREDIABETES; it is to occupy our attention in this article.

Definition
The concept of prediabetes was then proposed an arduous analysis based on the Diabetes Prevention Program on March 27, 2003, by the American Diabetes Association (ADA) defines it as:

"A state that precedes diagnosis of type 2 Diabetes This condition is common, and is in epidemiological increase is characterized by the rise in the concentration of blood glucose beyond normal levels without reaching values ​​diagnoses diabetes." diagnosis of prediabetes

How important is your diagnosis?
The detection of prediabetes in the initial recognition and maritime newspapers represents a high value for the physician and the crew taking into consideration that most people with this diagnosis eventually develop overt diabetes type II, over a period of 10 years. On the other hand it is closely related to the metabolic syndrome is the association of a set of metabolic disorders such as overweight, high triglycerides, high blood glucose and high blood pressure which also means that pre-diabetes is an indicator of high risk for vascular disease atherosclerosis (accumulation of fat, cholesterol and other substances in the arteries).

As prediabetes diagnosed?
In any medical evaluation or examination anamnesis in order to collect data we call history of interest, such as poor eating habits, sedentary lifestyle, family and others with diabetes it is important. A simple sample of venous blood in patients with fasting for eight hours, will allow us to determine glucose levels in plasma, if the result is a value between 100 and 129 mg / Udl are facing the possible presence of Prediabetes according to the American Diabetes Assciotation (ADA)

For the diagnosis besides fasting glucose, you should consider the following clinical manifestations and laboratory
Acanthosis nigricans # Presence
 * 1) Age: any age with a history, mandatory rule in over 45 years
 * 2) Waist circumference: men over 94 inches and women over 88 cm
 * 3) BMI greater than 25 kg / m2
 * 4) Family history of type ii diabetes: first degree
 * 5) HDL less than 40 mg / dl in men and less than 50 mg / dl in mugres
 * 6) Arterial hypertension
 * 7) Glycated Hemoglobin greater than 6%
 * 8) History of gestational diabetes
 * 9) Polycystic ovary syndrome
 * 10) History of cardiovascular disease
 * 1) Low birth weight
 * 2) Family, children, women with obesity (the culture of eating and activity fysica)

Treatment
Once the diagnosis is made according to scientific evidence the treatment is aimed primarily at lifestyle changes pursuing the goal of controlling overweight and increase physical exercise. If these measures are not sufficient within a reasonable time, intervention with drugs that increase insulin sensitivity or blocking the absorption of carbohydrates is necessary but there is so far no evidence to support the fact believe that drug treatment is than change lifestyle.



Prevention
A good tip to prevent the onset of Type II IS THE FOLLOWING:
 * 1) Do not let the fear of diagnosis is to decide about their health
 * 2) In the first year after the diagnosis of prediabetes made seek professional help control overweight personalized diet
 * 3) If you are not overweight fosters health with healthy nutrition
 * 4) Make physical activity 30 minutes per day
 * 5) The goal should be aimed at reduction greater than or equal to 5% of their weight and achieve a lower glucose 100 mg / dl

Prediabetes and maritime work
A crewman with prediabetes is suitable for maritime work without restriction if no other finding that conditions their work, but need to perform regular checkups to monitor your progress. Remember that a fasting blood glucose levels between 100 and 125 mg / dl is normal and does not mean that you have type II diabetes, but it is enough to dismiss it and raise the way to getting it called prediabetes.

In the maritime labor sedentary lifestyle, overweight and poor nutritional habits are configured as risk factors for developing metabolic disease and only the intervention through actions that promote health on board, such as changing lifestyle contribute positively.

Dra. Maite Duque Maritime-emergency room doctor Medicine Venezuelan Society of Maritime Medicine medicinamaritima@libero.it

[Https://revistamaritima.wordpress.com/2015/12/22/prediabetes-y-trabajo-maritimo/ Prediabetes in the Maritime Magazine (Venezuela) 22 Dec 2015]
--IMHAR 15:13, 28 September 2016 (UTC)