JoAnne Zoller Wagner's diagnosis as prediabetic wasn't enough to compel her to change her habits and lose 30 pounds. Not even with the knowledge her sister had died because of diabetes.
"I didn't have that sense of urgency," said the Pasadena, Md., woman.
But nine months later, doctors told Wagner her condition had worsened. She, too, now had Type 2 diabetes.
That scared her into action.
Now, two years later, the 55-year-old woman has slimmed down. She exercises regularly and her blood sugar levels are back in the healthy, normal range. Thanks to her success, she was able to avoid diabetes medication.
Diabetics like Wagner who manage to turn things around, getting their blood sugar under control — either escaping the need for drugs or improving enough to quit taking them — are drawing keen interest from the medical community.
This summer an American Diabetes Association task force will focus on this group of patients and whether they can be considered "cured." Among the points of interest:
- What blood sugar range qualifies as a cure and how long would it have to be maintained?
- How might blood pressure and cholesterol, both linked to diabetes, figure into the equation?
- And what if a "cured" diabetic's blood sugar soars again?
"For right now, we're not saying they're cured, but the bottom line is ... good glucose control, less infections," said Sue McLaughlin, president of health care and education for the American Diabetes Association. The organization has no estimate of how many people fall into that category.
Most diabetes linked to obesity
Being overweight is the leading risk for Type 2 diabetes. Genetics also plays a role, and blacks, Hispanics and American Indians are at greater risk than whites.
Nearly 57 million Americans are considered prediabetic. Another 18 million have been diagnosed with diabetes, while the diabetes association estimates almost 6 million more Americans have diabetes and don't know it. About 90 to 95 percent of diabetics have Type 2, the kind linked to obesity.
The future is potentially even gloomier, with one study estimating that one of every three children born in the U.S. in 2000 will eventually develop diabetes.
But the news isn't all bad. Thirty minutes of daily exercise and a 5 to 10 percent loss in body weight can lower the odds of diabetes by nearly 60 percent and is more effective than medicine in delaying its onset, according to a diabetes prevention study.
Still, such lifestyle changes are often difficult.
"It sounds like such a nonmedical recommendation, and yet it's the thing people say is the toughest to implement," said McLaughlin, the diabetes association official.
For Wagner, it meant changing not just her diet, but her lifestyle. A teacher, she now cooks most of her meals at home and avoids the sweets in the school lounge. She also tries not to stay late at work, using the extra time to exercise and make healthy meals.
‘It is about willpower’
Alice Stern describes a similar journey back to health since her diabetes diagnosis in 2007. The 50-year-old Boston woman was able to avoid diabetes drugs through diet and exercise, managing to trim 40 pounds off her 5-foot-2 frame.
"It is about willpower. That's how you make the changes," said Stern.
Even diabetics who have resorted to weight loss surgery have seen their blood sugar levels return to normal.
Lucy Cain, 61, of Dallas tried to control her diabetes through diet and exercise after she was diagnosed in 2004. But she found it difficult, and two years later had gastric bypass surgery. The 5-foot-7 Cain, who once weighed over 300 pounds, is down to about 185, still losing weight and is off diabetes medication.
Whatever the route, weight loss is key, doctors say.
"There is no special diet. You've got to eat fewer calories than your body burns," said Dr. Robert Rizza, a Mayo Clinic endocrinologist and former president of the American Diabetes Association.
Many doctors stop short of calling these successful patients cured.
Dr. Philipp Scherer, director of the diabetes research center at University of Texas Southwestern, describes diabetes as a one-way road. He said it can be stopped in its tracks with diet and exercise, but there's no turning back.
Dr. Kevin Niswender, an assistant professor in the department of medicine at Vanderbilt Medical Center, said "technically, you could call somebody cured," but that patient still needs to be followed closely.
Benefits may be only temporary
Doctors caution that, for some diabetics, lowering blood sugar may be only temporary. Stress, weight gain and other factors can push it back to unhealthy levels.
"Blood sugars can come down to normal. Then the issue is how long does that last?" said Dr. Sue Kirkman, vice president of clinical affairs for the diabetes association. "Sometimes people start putting weight back on and their blood sugars come back up."
In other cases, patients are diagnosed so late that blood sugar levels can't be brought back to normal, even with weight loss, she said. As the disease progresses, even those who made diet and lifestyle changes might eventually have to go on medications.
That's one reason Wagner and some other diabetics who've managed their disease through diet and exercise are also reluctant to consider themselves "cured."
"American culture, our environment, is not conducive to having good health," said Wagner. She believes diabetes will always be lurking in the background, waiting for her to slip.