Oct. 30 — Nearly 20 million Americans are headed down the road to diabetes, but modest weight loss and a bit more activity would be enough to turn them around. These people have prediabetes, meaning their above-normal blood sugar levels signal a high risk of developing type 2 diabetes within the next 10 years.
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A combination of obesity, inactivity and genetics is responsible. But most people with prediabetes aren’t aware they have it, and insurers may not cover testing for or treatment of the condition.
“It’s really quite a remarkable opportunity, but it’s not as if everyone is rushing to be identified,” says Dr. Daniel Einhorn of the Scripps Whittier Institute for Diabetes in La Jolla, Calif. Many people may be reluctant to get tested — and labeled — especially if they’re feeling fine, he adds. But catching the condition before it turns into full-blown diabetes can be a lifesaver.
People with Type 2 diabetes either lose the ability to respond to insulin, or their bodies no longer make enough of the hormone. Insulin helps the body use glucose as fuel, so without it sugar builds up in the bloodstream. Over time, especially if blood sugar levels are not kept in check, diabetes can boost a person’s risk of heart disease and cause damage to the eyes, kidneys, nerves and other body tissues.
Prediabetes used to be called impaired fasting glucose, but federal officials and diabetes experts introduced the new name last year. The term is not only more consumer-friendly, but does more to convey the urgency of the condition, says Dr. Gene Barrett, president of the American Diabetes Association.
Prediabetes is like the warning light in your car that clicks on when you’re about to run out of gas, says Roberta Anding, a registered dietitian and certified diabetes educator at Texas Children’s Hospital in Houston. There’s danger ahead, she explains, but it’s in your power to do something about it.
Weight loss and exercise help
Weight loss and exercise really will help, experts say, and there’s no need to pare off every extra pound or undertake an elaborate, strenuous exercise program. The Diabetes Prevention Program study found that people with prediabetes who walked or did other exercise for a half-hour at least five times a week and lost 5 to 7 percent of their total weight cut their risk of developing full-fledged diabetes by nearly 60 percent. The lifestyle changes were twice as effective as taking a pill.
While people in this study got extensive support for their efforts, including one-on-one counseling and intensive follow-up, other trials in which patients got less intense support have had similarly good results, notes Barrett. “There are lots of ways to do it without quite all those bells and whistles,” he adds.
What can really help people stay motivated, Barrett says, is periodic contact with a health professional like a nutritionist or nurse — even just a five-minute phone call every week or two. Many institutions and hospitals have programs that offer such interventions, but patients themselves will likely have to foot at least some of the bill.
People with prediabetes belong to a larger group of individuals with a condition known as insulin resistance syndrome (IRS), in which the body gradually loses sensitivity to the key blood-sugar-regulating hormone.
Individuals with IRS tend to have a family history of heart disease and diabetes, as well as a characteristic type of obesity in which weight settles around the abdomen rather than below the waist, high levels of triglycerides in the blood, high blood pressure, and low levels of “good” HDL cholesterol. They are also at risk of heart disease and may face a greater chance of developing certain cancers.
While most people with IRS have normal blood sugar levels, roughly 20 percent have levels that climb out of the normal range, and are considered to have prediabetes.
The ADA recommends doctors screen everyone 45 and older for prediabetes, particularly obese people, and that those with certain risk factors be tested earlier.
In late October, the ADA broadened its definition of prediabetes to include people with fasting blood glucose levels of 100 milligrams per deciliter (mg/dL) of blood. Previously, the cutoff point had been 110 mg/dL. This shift increased the population of prediabetics by 20 percent.There’s no one quick test to identify prediabetes. Instead doctors look at several different factors before making the diagnosis.
If you are diagnosed with prediabetes, what should you do? “See your doctor a couple of times a year,” Einhorn says. “Meet with a registered dietitian, an exercise physiologist, learn how to become fit, to eat thoughtfully.”
While insurance coverage for prediabetes care is lacking, Einhorn notes, some nutrition programs may be partially covered or offered at a nominal fee.
The ADA can help you find certified diabetes educators, support groups and diabetes education programs in your neighborhood.
People with prediabetes may also benefit from certain medications, including baby aspirin and niacin, the diabetes drug metformin, and mild blood pressure medications such as ACE inhibitors and angiotensin receptor blockers.
Eric Goodis is living proof that diabetes can be beat with weight loss and exercise. Diagnosed in 2001, when he was 140 pounds overweight and sedentary, the San Diego record-label owner went on diabetes medication and started watching his diet and exercising more. Within six months he no longer needed the medication and was able to get off the drugs he’d also been taking for high blood pressure and high cholesterol. He managed to lose all his excess weight in 11 months, and is now, at 52, an avid cyclist logging 200 miles a week with no signs of diabetes.
Goodis began his exercise program very slowly — because he had to. “It was almost strolling and it was the best I could do,” he remembers. He took two walks a day, and on each walk would push himself to pass one more house before he turned around. And as he became more active and the weight came off, it got easier to follow his diet.
“The first thing I would tell people is ‘don’t panic, it’s manageable,’” Goodis said. “It is manageable if you take it piece-by-piece, hour-by-hour, day-by-day. It’s almost kind of like those 12-step programs.”
Other advice? Get educated about diabetes, work closely with your doctor, don’t be addicted to the scale and don’t get discouraged, Goodis says. “It’s not a steady road to improvement,” he explains. “You kind of have up days and down days.”
Goodis gave himself a year to lose the weight, and advises others to give themselves a similarly generous time frame. “It goes a lot quicker than you think.”
Anne Harding is a New York City-based health journalist.
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