Prediabetes Facts

Pre-Diabetes

Before people develop type 2 diabetes, they almost always have an asymptomatic condition called "pre-diabetes." Also known as "impaired glucose tolerance," pre-diabetes is a term that refers to the 18.2 million people in the U.S. who have blood glucose levels that are higher than normal, but are not high enough to be classified as a range of diabetes. These people usually have no symptoms and treatment started early after the diagnosis can prevent progression to diabetes. In terms of health outcomes, prevention of the disease is better than treatment after the diagnosis.

More and more, doctors are recognizing the importance of recognizing pre-diabetes as treatment of the condition may keep over type 2 diabetes at bay. In addition, many studies show that the damage that occurs in type 2 diabetes to the heart, blood vessels, eyes and kidneys starts during pre-diabetes -- and prevention of diabetes may slow down that damage.

Who's At Risk For Developing Type 2 Diabetes?

People with a family history of type 2 diabetes
Women who had gestational diabetes or have had a baby more than 9 pounds
Women who have polycystic ovary syndrome (PCOS)
African Americans, Native Americans, Latinos, and Pacific Islanders, minority groups that are disproportionately affected by diabetes
People who are overweight or obese especially around the abdomen
People with high cholesterol, high triglycerides, low good 'HDL' cholesterol and a high bad 'LDL' cholesterol and high blood pressure. This cluster of problems is known as the metabolic syndrome or insulin resistance.
People who are inactive
Older people. As people age they are less able to process glucose appropriately and therefore have a greater risk of developing type 2 diabetes.

What Are the Symptoms?
Most people with pre-diabetes have no symptoms at all.

Symptoms of diabetes include unusual thirst, a frequent desire to urinate, blurred vision, or extreme fatigue.

Who Should be Tested for Pre-Diabetes?
You should be tested if:

You're over 45 years of age
You have any risk factors for diabetes
You're overweight with a BMI (body mass index) over 25
You belong to a high risk ethnic group
You were know to previously have an abnormal glucose tolerance test or have an impaired fasting glucose level
History of gestational diabetes or delivering a baby that weight more than 9 lbs
Having what appears as the metabolic insulin resistance syndrome - high triglycerides and low HDL, central obesity and hypertension

If your weight is normal and you're over age 45, you should ask your doctor during a routine office visit if testing is appropriate.

How Is Pre-Diabetes Diagnosed?
Your doctor can perform two different blood tests to determine if you have pre-diabetes.

The fasting plasma glucose test -- is a test where your blood glucose level is measured after an 8 hour fast. This test can determine if your body metabolizes the sugar, glucose correctly.

If your blood glucose level is abnormal after the fasting plasma glucose (FPG) test, you could have what's called "impaired fasting glucose." A normal FPG is less than 100 mg/dL (milligrams per deciliter); people with pre-diabetes have an FPG of 100 mg/dL - 125 mg/dL; people with diabetes have FPG's of greater than 126 mg/dL.on two or more blood sugar tests.

The other test your doctor can perform is called the oral glucose tolerance test (OGTT). During this test, your blood sugar is measured after a fast and then again 2 hours after drinking a beverage containing a large amount of glucose. Two hours after the drink, if your glucose is higher than normal, you have what's called "impaired glucose tolerance." A normal OGTT is under 140 mg/dL; people with pre-diabetes have an FPG of 140 mg/dL to 199 mg/dL; people with diabetes have FPG of above 200 mg/dL.

Both tests are accurate at diagnosing pre-diabetes. Both impaired fasting glucose and impaired glucose tolerance are pre-diabetes.

Why Is It Important to Recognize and Treat Pre-Diabetes?
Doctors recognize that people with pre-diabetes are at higher risk of cardiovascular disease (such as heart disease or stroke.) People with pre-diabetes have a 1.5-fold risk of cardiovascular disease compared to people with normal blood glucose. This is because abnormalities in the arteries, lipids profile and blood pressure problems start before the diagnosis of diabetes.

A large 3 year study done recently in patients at risk of developing type 2 diabetes has shown that lifestyle changes with exercise, mild weight loss and treatment with drugs that work to sensitize a person to the actions of insulin, a person with pre-diabetes can decrease the chance of getting type 2 diabetes by up to 60%. Changing a person's lifestyle habits with increased physical activities and mild weight loss was more effective than medications at reducing the risk of developing the disease. For some people with pre-diabetes, intervening early can actually return elevated blood glucose levels to the normal range.

What's the Treatment?

Lose weight. Portion control/ caloric restriction in a well balanced diet as well as a 5 to 10% change in weight can make a huge difference.
Exercise. Try to walk 30 minutes a day, 5 days a week. The activity can be split into several short periods: 3 sessions of 10 minutes. Select an activity that you enjoy such as walking. In the study above the total amount of exercise per week was 150 minutes.
Stop smoking.
Treat high blood pressure and high cholesterol.
Eat a heart healthy diet.

Source: Healthwise