16 March 2012

Colleen Schultz was stunned to learn that her blood sugar level was high during a routine doctor visit in the fall of 2010. Though she did not have diabetes, her results were in the prediabetes range. “I was very upset,” says Schultz, a drapery fabricator in Voorheesville, N.Y. “It was depressing thinking I was falling apart. I didn’t want to take medications for the rest of my life.”

Her doctor gave her a prescription, which Schultz tried and then decided she’d rather focus on her doctor’s other advice: Eat better and get more exercise. With her doctor’s approval, she did just that. Schultz gave up alcohol and fried foods and took up walking, yoga, and Zumba. In three months, Schultz lost 11 pounds, and her blood sugar level dropped, though she still had prediabetes.

Schultz is one of the estimated 79 million people in the U.S. who have prediabetes, a condition in which blood sugar levels are slightly elevated, but not high enough to qualify for diabetes. Having prediabetes increases a person’s risk of developing type 2 diabetes within the next 10 years.

“Whether prediabetes is a disease or not is a matter of opinion (among doctors and health care companies) but it’s clearly a wake-up call, and people who have it have to do something about it,” says Edward Horton, MD, a professor of medicine at Harvard Medical School and a senior investigator at the Joslin Diabetes Center in Boston. “As a society, we have to take it seriously.”

Making the Diagnosis

Determining whether you have prediabetes typically involves undergoing a fasting plasma glucose test (FPG) or an oral glucose tolerance test (OGTT). Both are blood tests that require an overnight fast.

Normal fasting blood glucose is below 100 mg/dl. Prediabetes is defined as a fasting blood glucose level between 100 and 125 mg/dl. If a person has at least two fasting blood glucose levels at 126 mg/dl or above, they have diabetes.

For the OGTT, a person’s blood glucose is measured after a fast and two hours after drinking a glucose-rich beverage. Normal blood glucose drops below 140 mg/dl two hours after the drink. But if you have prediabetes, your two-hour blood glucose is between 140 and 199 mg/dl. If your two-hour blood glucose is 200 mg/dl or above, you have diabetes.

Some doctors may also use the A1C test, or glycated hemoglobin test. This test measures your average blood sugar level for the past two-to-three months. A level between 5.7 and 6.4 is prediabetes.

Knowledge Is Power

Unlike Schultz, few people with prediabetes know they have it. “Most people are not diagnosed with prediabetes because many doctors may never have that conversation with their patients,” says Ann Albright, PhD, RD, director of the CDC’s division of diabetes translation. She says that in a CDC study, only 7% of patients said they have ever been told that they have prediabetes.

Some people are never even tested; others disregard what their doctors are telling them. And because prediabetes typically doesn’t cause any symptoms, most people won’t suspect anything is wrong.

But the excess glucose in prediabetes may be already causing damage in some people, Horton notes. Inside the eyes, some people with prediabetes are already experiencing microaneurysms — a widening of the blood vessels that can result in weakness and rupture. Eventually, these microaneurysms can lead to diabetic retinopathy, a condition that can lead to vision loss. Others may already have protein in the urine, which is an early sign of kidney damage caused by the excess glucose.

Research shows that prediabetes also boosts your risk for developing cardiovascular disease, the nation’s leading cause of death. “People who have prediabetes have a 1.5-[fold] increase in their risk for cardiovascular disease compared to healthy people,” Albright says. “You have a two- to fourfold increase in that risk if you have diabetes.”

Of course, having prediabetes means you may be on the way to developing diabetes, especially if you have other risk factors such as advancing age, family history, being overweight and inactive, and being a member of certain ethnic groups. But it doesn’t necessarily have to become diabetes — in many cases you can still turn it around.

Stopping Prediabetes From Becoming Type 2 Diabetes

The good news is that having prediabetes doesn’t mean you’re doomed to develop type 2 diabetes. Since age, family history, and ethnicity are factors you can’t change, preventing diabetes must focus on exercise and weight loss, Albright says.

Making the right lifestyle changes can halt the progression toward type 2 diabetes — or at least delay it, Horton says. Losing just 5% to 7% of your body weight and exercising 30 minutes a day, five days a week, reduced the incidence of type 2 diabetes by 58% over nearly three years in a landmark study called the Diabetes Prevention Program.

Horton recommends that people exercise 150 minutes a week. “The more you do the better off you are,” he says. But that doesn’t require extreme activity. “We’re not saying you have to go to the gym and pump iron,” Horton says. “All you have to do is walk and find ways to move more.” He also recommends eating a heart-healthy diet that includes lots of fruits and vegetables and limiting saturated fats and trans fats. “We recommend you get 30% or fewer calories from fat, and less than 10% of your calories from saturated fat,” he says.

To help inspire people, the CDC has created a National Diabetes Prevention Program, which includes a partnership with the YMCA and UnitedHealth Group. The YMCA program provides 16 weekly sessions on healthy living, including discussions on how to cut back on fat and calories, become more active, and cope with stress. The CDC’s web site predicts that, in time, more organizations will become involved in the program.

Wade Heyer, 51, a real estate broker in Shoreline, Wash., was struggling with prediabetes when he joined the program. At 265 pounds, he had a family history of diabetes and was taking medications for high cholesterol and high blood pressure. He also had sleep apnea and gout. “There’s no question in my mind that I was heading for diabetes,” he says.

A year after participating in the diabetes prevention program, Heyer has lost 50 pounds and is on the brink of quitting his medications. He hasn’t used a CPAP (continuous positive airway pressure) machine while sleeping in months. He rides his bike to and from work daily, goes to the Y at least once a day, and takes a spin class three times a week. He also eats lots of fish, fruits, vegetables, and whole grains. His prediabetes is gone — and so is the threat of type 2 diabetes. “It’s been an amazing transformation,” Heyer says. “I can’t tell you how good I feel. I even handle stress better.”

This article was published in www.webmd.com on 3 October 2011.