Could You Have Pre-Diabetes?
by Elizabeth Smoots, MD
Just as pre-cancer may be detected and removed before turning
into cancer, discovery of diabetes in its earliest stages can
help prevent the development of full-blown diabetes.
That, in a nutshell, is the idea behind the new term “pre-diabetes.”
Blood glucose levels that are higher than normal but not high
enough to be called diabetes are now classified as pre-diabetes.
This name replaces older terminology such as impaired glucose
tolerance and impaired fasting glucose—a change I applaud.
I think the concept of pre-diabetes will make it easier for those
at risk to thwart progression to frank diabetes.
Exciting evidence indicates that people with pre-diabetes can use
simple, readily available means to return their blood glucose
levels to the normal range.
This can help prevent or delay complications that
research has linked to both diabetes and the
pre-diabetic state.
Here, I've summarized the prominent features of pre-diabetes I
think you need to know.
How Serious a Problem?
Research shows that people with pre-diabetes are at risk for
the same complications that are seen with diabetes.
These include impaired vision or blindness, heart disease, stroke,
kidney failure, nerve damage, and infections leading to leg
amputations.
If you have pre-diabetes you may already be experiencing the
adverse health effects of this serious condition.
People with pre-diabetes have a 1.5-times increased risk of
cardiovascular disease—including heart attack, stroke and arterial
disease—compared to people with normal blood glucose.
In contrast, people with diabetes have a 2- to 4- times increased
risk of cardiovascular disease. Both diabetics and pre-diabetics
are more likely to develop additional cardiac risk factors such
as elevated cholesterol, high blood pressure, and obesity.
An Epidemic of Diabetes
Lack of exercise and super-sized portions are fueling twin
epidemics of obesity and diabetes in this country.
In the past 10 years the incidence of obesity has increased
61 percent and new cases of diabetes have gone up 49 percent.
The majority of Americans are now overweight and at risk for
developing pre-diabetes and type 2 diabetes.
Both of these conditions make your body cells less sensitive
to the effects of insulin, a hormone that regulates blood
glucose levels. This allows blood sugar levels to rise over
time and can result in long-term damage to your body.
Detection of Pre-Diabetes
Millions of Americans are currently considered candidates
for pre-diabetes and diabetes screening. Both conditions
can be diagnosed with a simple blood test. During a routine
office visit your doctor can order one of two tests:
Fasting plasma glucose test – you will fast overnight and have
your blood glucose measured in the morning before eating.
Your results may be read as follows:
Normal: below 100
Pre-diabetes: 100-125
Diabetes: 126 or above
Oral glucose tolerance test – you will fast overnight and have
your blood glucose measured after the fast. Then you'll drink
a sugary drink and have your blood glucose measured two hours later.
Results two hours after the drink are usually read as follows:
Normal: below 140
Pre-diabetes: 140-199
Diabetes: 200 or above
Who Should Get Screened?
Experts from the American Diabetes Association and the National
Institutes of Health recently developed screening guidelines for
pre-diabetes. They recommend glucose testing every three years for
people aged 45 or older who are overweight (BMI above 24).
If you’re over age 45 but not overweight ask your doctor if testing
is appropriate.
For those under age 45 and overweight, testing may be advisable
if you have another risk factor for pre-diabetes.
Risk factors include:
High blood pressure
Low HDL (good) cholesterol level
High triglyceride level
Family history of diabetes
History of diabetes during pregnancy (gestational diabetes)
Giving birth to a baby weighing more than nine pounds
Belonging to an ethnic group other than Caucasian
Care of Pre-Diabetes
If your glucose test indicates pre-diabetes you should have it
repeated for accuracy. People with a diagnosis of pre-diabetes
also need retesting every one to two years. Without intervention,
studies show that most people with pre-diabetes go on to develop
type 2 diabetes within 10 years.
Fortunately, we know that people with pre-diabetes can delay or prevent
the onset of diabetes with lifestyle changes. Experts recommend that
people with pre-diabetes reduce their weight by 5-10% and engage in
modest physical activity for 30 minutes most days of the week.
A recent study in the New England Journal of Medicine followed a
large group of pre-diabetics who made these changes. After an average
follow-up of three years, they achieved nearly a 60% reduction in
diabetes risk compared to only about a 30% reduction for those
on medication.
I’d say it’s a powerful reason for anyone at risk for diabetes
to control weight and exercise regularly—with your doctor’s
okay of course.
RESOURCES:
American Diabetes Association
http://www.diabetes.org/
Centers for Disease Control and Prevention
http://www.cdc.gov/
National Diabetes Education Program
http://ndep.nih.gov
National Institute of Diabetes and Digestive and Kidney Diseases
http://www.niddk.nih.gov/
