The sleeping giant that is pre-diabetes continues to slowly reveal itself in ever-scary figures published in the UK news this week.

As the commonest cause of sight loss in the under 60s in the UK, I suggest that all eye care professionals need to keep up to date with what is happening in the diabetes world. There are many risk factors, such as poor diet and lack of exercise, that are known to influence the expression of the disease, either in developing the pre-diabetic state where the development of the full-blown disease is more likely, and in causing the many varied problems of the disease itself once established, including sight loss. Surely identifying the disease at the pre-diabetic stage would allow targeted advice and enable a lower ‘disease conversion.’

Research published this week in Experimental Physiology suggests that testing for insulin resistance, a measure of how responsive the body is to insulin, can be used for ‘early detection of the likelihood of developing type 2 diabetes’ and therefore pre-diabetes. Type 2 diabetes is normally detected by testing for high blood sugar levels, which is a sign of the condition. By identifying pre-type 2 diabetes even earlier, researchers suggest, action can be taken ‘before these patients potentially develop cardiovascular disease’ (and presumably other complications too).

Nearly six years ago, we published some features looking at the detection of autofluorescence in the crystalline lens as a measure of pre-diabetes (Optician 28.07.14). This non-invasive and easy to perform test (with the correct instrument) showed significant reliability in detecting pre-diabetes. At the time, I asked a diabetologist for their thoughts. They suggested that testing for pre-diabetes was not helpful and instead health messages should go out to all and blood-testing continue for diagnosis once diabetes is established. Perhaps this view is now changing – has the time finally come for crystalline lens screening?