Could you have pre-diabetes?
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. It is hoped that 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. Below is a summary of the prominent features of pre-diabetes that are important 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 110
- Pre-diabetes: 110-125
- 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. 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, 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. That is a powerful reason for anyone at risk for diabetes to control weight and exercise regularly-with your doctor's ok of course.
Resources:
American Diabetes Association
http://www.diabetes.org/
National Diabetes Education Program
http://ndep.nih.gov
Centers for Disease Control and Prevention
http://www.cdc.gov/
National Institute of Diabetes and Digestive and Kidney Diseases
http://www.niddk.nih.gov/
Sources:
"Position Statement: The prevention or delay of type 2 diabetes," American Diabetes Association and National Institute of Diabetes, Digestive and Kidney Diseases.Diabetes Care, April 2002, p. 742-9.
"Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin," Diabetes Prevention Program Research Group. New England Journal of Medicine, Feb 7, 2002, p. 393-403.
"Pre-Diabetes," American Diabetic Association. http://www.diabetes.org/, accessed June 25, 2002.
"The continuing epidemics of obesity and diabetes in the United States." Journal of the American Medical Association, Sept 12, 2001, p. 1195-1200.
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