Prediabetes A Precursor to Diabetes

Many people know that diabetes is a dangerous systemic illness that can lead to serious complications such as heart disease, blindness, kidney failure, and amputations.

What many do not realize is that the seeds of those complications take root long before someone succumbs to full-blown diabetes.

During that period, called prediabetes, individuals at risk exhibit elevated blood-sugar levels but are still capable of processing that sugar, called glucose - the energy that powers the body's cells.

Some 41 million Americans are estimated to have prediabetes, according to recently revised government guidelines.

And because November is American Diabetes Month, physicians are taking the opportunity to warn people that even if they do not have diabetes, their bodies still may be suffering damage from elevated blood sugar.

"If we can identify people before they get to the point of having diabetes, we can intervene," said Cathy Tibbetts, president of health care and education for the American Diabetes Association.

"In about 58 percent of the cases, with healthier eating and increased physical activity and a moderate loss of weight, people can successfully avoid diabetes or delay its onset."

Diabetes at Epidemic Numbers

About 18 million Americans have diabetes, with 1.3 million new cases diagnosed annually. It is the sixth leading cause of death in the US, with an estimated 200,000 deaths every year, according to federal statistics.

While an estimated 13 million people have been diagnosed with diabetes, 5.2 million people are unaware they have the disease, the American Diabetes Association reports.

Diabetes is a disease in which the body does not produce or properly use insulin, a hormone that is needed to convert sugar, starches, and other food into energy for cells.

Most people have type 2 diabetes, which develops as the body gradually loses its ability to metabolize blood sugar.

The US government adopted new guidelines this year for determining whether a person is at risk for diabetes. Under those guidelines, two of every five adults ages 40 to 70 is now considered to have prediabetes.

Under previous guidelines, a person was considered to have prediabetes if his or her sugar level after an all-night fast was 110 milligrams per deciliter of blood. Now, prediabetes is diagnosed for sugar levels between 100 and 125 mg/dl.

The change makes sense given that those elevated levels are doing harm to the body even though the person is not suffering from diabetes, says Dr. Robert Rizza, a professor of medicine at the Mayo Clinic's Division of Endocrinology, Metabolism, Diabetes, and Nutrition.

"If you look at people whose blood sugars are at that level, you can already find evidence of the damage caused by diabetes," Dr. Rizza says.

For example, people with prediabetes have a 50 percent greater risk of heart attack and stroke, Tibbetts says. Once they actually have diabetes, their risk of heart disease increases to two to four times that of someone without diabetes.

People whose post-fast blood sugar falls between 100 and 110 have a 20 percent higher chance of developing diabetes than those whose blood sugar is healthier.

Those with blood sugar between 110 and 125 are at 40 percent greater risk. Levels of 126 or above are considered diabetes.

What Are the Steps to Prevent Prediabetes?

The American Diabetes Association believes the rampant spread of diabetes and its precursors is caused by factors that can be managed by the individual.

"We've gotten into some bad habits as a society," Tibbetts says. "We're less physically active and eating larger and larger amounts of food."

Since 1990, obesity has increased by more than 60 percent in the US. And type 2 diabetes, which is closely linked to obesity, has soared by nearly 50 percent, according to the diabetes association.

People with prediabetes can avoid or delay the onset of full-blown disease by eating sensibly and becoming more active, Dr. Rizza notes.

"The most important thing is to stay lean and become fit," he says. "If you're overweight, lose weight. And if you're sedentary then increase your activity."

Losing just 5 percent of body weight - 10 pounds for a 200-pound adult - can bring a person's blood sugar down below prediabetes levels.

The diabetes association recommends that people exercise portion control. Simply eating less can go a long way toward arresting obesity.

Other association diet tips include:

These foods tend to be high in calories and fat and contain few vitamins and minerals.

Physical activity also is an important part of weight management, and thus an important way to avoid diabetes. Exercise can boost your metabolism, increase muscle mass so you burn more calories, and help improve the body's response to insulin and naturally help to lower glucose by burning extra calories.

Always consult your physician for more information.

November 2004

Prediabetes A Precursor to Diabetes

Diabetes at Epidemic Numbers

What Are the Steps to Prevent Prediabetes?

Obesity Prevention

Online Resources

Obesity Prevention

Many of the strategies that produce successful weight loss and maintenance help prevent obesity. Improving eating habits and increasing physical activity play a vital role in preventing obesity.

Recommendations for adults include:

• Eat five to six servings of fruits and vegetables daily. A vegetable serving is one cup of raw vegetables or one-half cup of cooked vegetables or vegetable juice. A fruit serving is one piece of small to medium fresh fruit, one-half cup of canned or fresh fruit or fruit juice, or one-fourth cup of dried fruit.

• Choose whole grain foods such as brown rice and whole wheat bread. Avoid highly processed foods made with refined white sugar, flour, and saturated fat.

• Weigh and measure food in order to be able to gain an understanding of portion sizes. For example, a 3-ounce serving of meat is the size of a deck of cards. Avoid supersized menu items.

• Balance the food “checkbook.” Taking in more calories than are expended for energy will result in weight gain. Regularly monitor weight.

• Avoid foods that are high in “energy density,” or that have a lot of calories in a small amount of food. For example, a large cheeseburger with a large order of fries may have almost 1,000 calories and 30 or more grams of fat. By ordering a grilled chicken sandwich or a plain hamburger and a small salad with low-fat dressing, you can avoid hundreds of calories and eliminate much of the fat intake. For dessert, have fruit or a piece of angel food cake rather than the “death by chocolate” special or three pieces of home-made pie.

• Remember that much may be achieved with proper choices in serving sizes.

• Accumulate at least 30 minutes or more of moderate-intensity activity on most, or preferably all, days of the week. Examples of moderate intensity exercise are walking a 15-minute mile, or weeding and hoeing a garden.

• Look for opportunities during the day to perform even ten or 15 minutes of some type of activity, such as walking around the block or up and down a few flights of stairs.

Always consult your physician for more information.

Online Resources

(Our Organization is not responsible for the content of Internet sites.)

American Diabetes Association

Centers for Disease Control and Prevention (CDC)

Everyday Choices, ADA, AHA, and ACS

HealthierUS.Gov

National Diabetes Education Program

National Diabetes Information Clearinghouse

National Institute of Diabetes & Digestive & Kidney Diseases

National Institutes of Health (NIH)

National Library of Medicine

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