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.
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 prevent or delay complications that research has linked to both diabetes and the pre-diabetic state.
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 diseaseincluding heart attack , stroke, and arterial diseasecompared 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% and new cases of diabetes have gone up 49%. Overweight causes diabetes and pre-diabetes in susceptible persons. Weight loss, even of a few pounds, can cure pre-diabetes or reduce its risk of turning into type 2 diabetes . This is especially important since the majority of Americans are now overweight and at risk for developing pre-diabetes and type 2 diabetes. Persons of Hispanic, Native American, or Indian subcontinent descent may be at even higher risk. 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 100Pre-diabetes: 100-125Diabetes: 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 140Pre-diabetes: 140-199Diabetes: 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 age 45 or older who are overweight (BMI above 24). If youre 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 pressureLow HDL (good) cholesterol levelHigh triglyceride levelFamily history of diabetes History of diabetes during pregnancy ( gestational diabetes ) Giving birth to a baby weighing more than nine poundsBelonging 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 1-2 years. Without intervention, studies show that most people with pre-diabetes 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. There have been some studies suggesting that certain medications may be of use in persons with pre-diabetes. Drug treatment remains controversial, but is supported by a number of experts.
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 References: American Diabetes Association and National Institute of Diabetes, Digestive, and Kidney Diseases. Position statement: the prevention or delay of type 2 diabetes. Diabetes Care . 2002 Apr:742-9. The continuing epidemics of obesity and diabetes in the United States. Journal of the American Medical Association . 2001 Sep 12:1195-1200. Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. New England Journal of Medicine . 2002 Feb 7:393-403. Pre-diabetes. American Diabetic Association website. Available at: http://www.diabetes.org/ . Accessed June 25, 2002. Last reviewed October 2006 by Lawrence Frisch, MD, MPH Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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