What Does It Really Mean to Have Prediabetes?

HCA imageType 2 diabetes usually occurs in adulthood as a result of genetics and lifestyle. It is characterized by abnormally high levels of blood sugar, known as glucose. Glucose is the primary source of energy for our cells that the body makes from food we ingest. The onset of diabetes is triggered when the body is no longer able to properly use insulin, the hormone that helps cells convert glucose into energy. When glucose stays in the blood stream instead of moving into the cells, nerves and blood vessels can be damaged, thereby increasing the risk of cardiovascular disease, stroke, blindness, kidney disease, and circulation problems.

Given that diabetes is costly, hard to treat, and approaching epidemic levels, its not surprising that interest in prediabetes is growing. The majority of people with prediabetes dont know they have it. Last year, experts from the American Diabetes Association (ADA) released results of their study to estimate the number of US adults who had prediabetes in 2000. They used data from a government nutrition study and identified prediabetic participants based on ADA criteria. In April of this year, the ADA released a revised, more accurate definition of prediabetes, which doubled the original estimate to an astounding 41 million people.

What is Prediabetes? Prediabetes is a condition that precedes the onset of diabetes. It is characterized by blood glucose levels that are elevated, though not high enough to be classified as diabetes. Doctors usually refer to prediabetes as impaired glucose tolerance. Other factors, which indicate the need for prediabetes screening, are: Family history of diabetesObesityHigh blood pressureHigh CholesterolSedentary lifestyle (defined as being physically inactive at work and at home and failing to participate in exercise for at least 20 continuous minutes at least three times a week)Certain ethnic groups (Hispanic/Latino, Asian American/Pacific Islander, Native American, or African American History of gestational diabetesHaving prediabetes means that you are at high risk for developing diabetes and may already be suffering adverse effects of elevated blood glucose. Despite not being as severe as diabetes, prediabetes is not a condition to ignore, as it is associated with an increased risk of cardiovascular disease and stroke. How Do You Know if You Have Prediabetes?Normal blood sugar readings are below 100 milligrams/deciliter (mg/dl [5.6 mmol/L]). Prediabetes is diagnosed when blood glucose levels are 100-125 mg/dl (5.6-6.9 mmol/L); diabetes is diagnosed if levels rise above 125 mg/dl (6.9 mmol/L). The ADA recommends a prediabetes screening for anyone older than age 45, or younger than 45 if one or more risk factors are present.
Simple blood tests are used to measure blood glucose levels. Depending on the test used, abnormal results indicate either impaired fasting glucose (IFG) or impaired glucose tolerance (IGT). According to ADA criteria, a diagnosis of either IFG or IGT indicates prediabetes. How to Prevent PrediabetesIt is possible to lower your risk of developing prediabetes; some people are even able to return their blood glucose levels to normal. Several recent studies provide evidence that lifestyle changesmoderate weight loss and exerciseare effective at slowing or even reversing progression toward diabetes.In a landmark study by the Diabetes Prevention Project in the US, a combination of lifestyle and drug interventions were used to treat 3,234 middle-aged, obese subjects with glucose intolerance. Results from the lifestyle intervention group, which had intensive instruction on weight loss, exercise, and behavior modification, showed that patients who lost 7% of their body weight and exercised 150 minutes per week reduced their incidence of diabetes by 58%. The drug intervention group also reduced their incidence of diabetes, but by a lesser 31%.Another well-designed study, reported by the Finnish Diabetes Prevention Study Group, achieved similar results. A total of 522 middle-aged, obese subjects with IGT were randomized into two groups: the control group, which received brief counseling on diet and exercise, and the intervention group, which received intensive individualized instruction on reducing weight and increasing physical activity. Again, results showed a 58% reduction in the incidence of diabetes in the intervention group compared with the control group.
What Can You Do if You Have Prediabetes?If you are diagnosed with prediabetes, its important to take action to manage your condition. Making small lifestyle changes can prolong, or even prevent, the onset of diabetes. Based on recent studies, the recommended treatment is weight loss through improved diet and physical activity. Reducing body weight by as little as 5% to 10% and exercising 30 minutes a day, five days a week, will contribute to successful treatment of prediabetes.Some people can take medication to manage their blood glucose levels, though lifestyle modification is favored over pharmaceuticals as the first approach to manage prediabetes. Because many of the lifestyle-related risk factors associated with diabetes are also risk factors for other health issues, making lifestyle changes to reduce your risk of diabetes may have a positive effect on your overall health.Talk with your doctor about implementing a plan to manage your condition. The National Diabetes Education program has created a prevention campaign called Small Steps, Big Rewards. Making small changes today will make a big difference in your long-term health. RESOURCES: American Diabetes Associationhttp://www.diabetes.org Centers for Disease Prevention and Control: Diabetes Public Health Resource
http://www.cdc.gov/diabetes National Diabetes Education Programhttp://www.ndep.nih.gov CANADIAN RESOURCES: Canadian Diabetes Associationhttp://www.diabetes.ca/ Canadian Family Physicianhttp://www.cfpc.ca/cfp/ Sources: American Diabetes Association and National Institute of Diabetes, Digestive and Kidney Diseases. 2002. The prevention or delay of type 2 diabetes. Diabetes Care 25 (4):1-8. Benjamin, Staphanie M., PhD and Rodolfo Valdez, PhD, et al. 2003. Estimated number of adults with prediabetes in the US in 2000: Opportunities for prevention. Diabetes Care 26: 645-649. Diabetes Prevention Program Research Group. 2002. Reduction in the incidence of type 2 diabetes with lifestyle intervention or Metformin. The New England Journal of Medicine 346 (6): 393-403. Kanaya, AM, and KM Narayan. 2003. Prevention of type 2 diabetes: Data from recent trials. Primary Care 30 (3): 511-526. Narayan, KM, and G. Imperatore. Targeting people with prediabetes. 2002. British Medical Journal Aug 24; 325 (7361): 403-404. National Diabetes Information Clearinghouse. 2004.Am I at risk for type 2 diabetes? Taking steps to lower the risk of getting diabetes. National Institutes of Health. April.
Nathan, DM. Diabetes Care. 2007; 30:753. Sartor, G, Schersten, B, Carlstrm, S, et al. Ten-year follow-up of subjects with impaired glucose tolerance: prevention of diabetes by tolbutamide and diet regulation. Diabetes. 1980; 29:41. Tuomilehto, J., and J Lindstorm, et al. for the Finnish Diabetes Prevention Study Group. 2001. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 344: 1343-1350. Websters New World Medical Dictionary. 2000. IDG Books Worldwide, Inc. Foster City, CA. Last reviewed May 2008 by Marcin Chwistek, MDPlease 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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