Diabetes has grown to pandemic proportions. It is estimated that 8.3% of the US population,or 25.8 million people, have diabetes. About 95% of these have type 2 diabetes. Diabetes is the main cause of kidney failure, limb amputation, and new-onset blindness in American adults. People with diabetes are more likely than people without diabetes to develop and die from diseases of the heart and blood vessels, called cardiovascular disease. Adults with diabetes have heart disease death rates about two to four times higher than adults without diabetes. The risk for stroke is two to four times higher among people with diabetes.
Prediabetes refers to the intermediate metabolic states between normal and diabetic glucose homeostasis. This term was first introduced in 1979 to replace 'borderline' diabetes. Pre-diabetes is becoming more common and more recognized in the United States. The U.S. Department of Health and Human Services estimates that 79 million Americans had prediabetes in 2007. It is estimated that 314 million people worldwide have prediabetes, and the number is projected to grow to 418 million in 2025.
Why worry about prediabetes? It has been estimated that between 35% and 65% of adults with prediabetes will develop type 2 diabetes within six years of the prediabetes diagnosis. Even before progressing into full blown diabetes, these people have an increased rate of microvascular (retinopathy, protein in the urine, polyneuropathy) and macrovascular (heart attack and stroke) complications.
How do you diagnose Prediabetes? Prediabetes is usually diagnosed with any one or more of the following blood test readings: A fasting blood glucose level of:110 to 125 mg/dL (6.1 mM to 6.9 mM, according to the World Health Organization criteria or 100 to 125 mg/dL (5.6 mM to 6.9 mM), according to the American Diabetic Association criteria. A blood sugar level of 140 to 199 mg/dL (7.8 to 11.0 mM) at the end of two hours after ingesting a standardized 75 gm glucose solution as part of a two hour glucose tolerance test. A glycated hemoglobin (HbA1c) between 5.7 and 6.4 percent.
Are you at risk? There are certain indications that you have or may be at an increased risk of developing prediabetes. These include increasing age, inactivity, sleeping less than 6 hours per day and being overweight or obese. Certain races are at an increased risk, namely Asian Americans, Hispanics/Latinos and non-hispanic blacks. Other risk factors include abnormal lipids, especially high triglycerides and low HDL (the good cholesterol) and diagnosed cardiovascular disease. If you had gestational diabetes (high blood sugar during pregnancy), or gave birth to a child weighing more than 9 lbs, you are also at risk. Two other rather uncommon conditions, namely polycystic ovarian syndrome and acanthosis nigrans also indicate increased insulin resistance and predisposition to prediabetes and diabetes. And finally, patients with psychiatric disorders, especially schizophrenia, on multiple psychotropic drugs, also have a high incidence of prediabetes.
Symptoms: Prediabetes is often asymptomatic and suspicion often rests solely on risk factors mentioned above. If present, the symptoms of prediabetes, are the same as those of diabetes: constant hunger, increased thirst and urination, unexplained weight loss, weight gain, generalized malaise, blurred vision, slow healing from minor wounds like cuts and bruises, tingling or loss of sensation in the hands or feet, frequent or recurring gum, skin, vaginal or bladder infections.
How do you treat? The call for early treatment of prediabetes is gaining momentum. Several recent studies have evaluated the role of life-style changes and medications for the treatment of this malady:
1. Exercise: Regular physical activity prevents progression into diabetes. In the Da Qing IGT and Diabetes Study of 110,660 men and women in China( Diabetes Care 1997;20:537-44.), progression to diabetes decreased from 67.7% to 41.1%, when comparing an uncontrolled group to a controlled exercise group over a period of 6 years.
2. Diet: In a Finnish study (N Engl J Med 2001;344:1343-50), there was an incidence of 23% of progression into diabetes in a control group compared to only 11% in an intervention group over a period of 4 years. Interventions were aimed at reducing weight 5% or more, reducing dietary fat to less than 30% of the total caloric intake and increasing dietary fiber to at least 15g per 1000 calories ingested.
3. In al large study involving 27 clinical centers around the US(N Eng J Med, February 7, 2002),3234 prediabetic overweight participants were divided into two groups. One group received intensive training in diet, physical activity, and behavior modification. The aim was to reduce body weight by 7% and maintain the loss, and exercise 150 minutes a week. The second group received metformin 850 mg twice a day. At the end of the study, the lifestyle intervention group reduced diabetes progression by 58% compared to 31% in the metformin group.
4. A prediabetes task force (American Association of Clinical Endocrinologists 18th Annual Meeting, Houston,Tx. 2009) suggested a more aggressive therapeutic approach to these patients, recommending treating high-risk individuals with diabetic medications such as metformin, acarbose, glucagon-like peptide 1 agonists and thiazolidinediones. These treatments are not yet FDA approved for prediabetes, but are backed by strong scientific data indicating that battling insulin resistance early protects the pancreas and prevents progression into diabetes.
The health and monetary costs of prediabetes are not known. But diabetes is an expensive disease, costing about $174 b billion annually in the US alone. Direct medical costs account for about $116 billion and indirect costs such as disability payments, time lost from work, and premature death account for the remaining $58 billion.
Millions of lives and billions of dollars can be saved by aggressive life-style and therapeutic intervention in patients suffering from prediabetes.
Remember: Prediabetes means preceding diabetes. But it also means preventable diabetes.
Dr. Shashi K. Agarwal is a Board Certified Internist and Cardiologist with a private practice in New York City and New Jersey. He is also a diplomat of the American Board of Holistic Medicine and the American Academy of Anti-Aging Medicine.
By Shashi Agarwal MD
Prediabetes refers to the intermediate metabolic states between normal and diabetic glucose homeostasis. This term was first introduced in 1979 to replace 'borderline' diabetes. Pre-diabetes is becoming more common and more recognized in the United States. The U.S. Department of Health and Human Services estimates that 79 million Americans had prediabetes in 2007. It is estimated that 314 million people worldwide have prediabetes, and the number is projected to grow to 418 million in 2025.
Why worry about prediabetes? It has been estimated that between 35% and 65% of adults with prediabetes will develop type 2 diabetes within six years of the prediabetes diagnosis. Even before progressing into full blown diabetes, these people have an increased rate of microvascular (retinopathy, protein in the urine, polyneuropathy) and macrovascular (heart attack and stroke) complications.
How do you diagnose Prediabetes? Prediabetes is usually diagnosed with any one or more of the following blood test readings: A fasting blood glucose level of:110 to 125 mg/dL (6.1 mM to 6.9 mM, according to the World Health Organization criteria or 100 to 125 mg/dL (5.6 mM to 6.9 mM), according to the American Diabetic Association criteria. A blood sugar level of 140 to 199 mg/dL (7.8 to 11.0 mM) at the end of two hours after ingesting a standardized 75 gm glucose solution as part of a two hour glucose tolerance test. A glycated hemoglobin (HbA1c) between 5.7 and 6.4 percent.
Are you at risk? There are certain indications that you have or may be at an increased risk of developing prediabetes. These include increasing age, inactivity, sleeping less than 6 hours per day and being overweight or obese. Certain races are at an increased risk, namely Asian Americans, Hispanics/Latinos and non-hispanic blacks. Other risk factors include abnormal lipids, especially high triglycerides and low HDL (the good cholesterol) and diagnosed cardiovascular disease. If you had gestational diabetes (high blood sugar during pregnancy), or gave birth to a child weighing more than 9 lbs, you are also at risk. Two other rather uncommon conditions, namely polycystic ovarian syndrome and acanthosis nigrans also indicate increased insulin resistance and predisposition to prediabetes and diabetes. And finally, patients with psychiatric disorders, especially schizophrenia, on multiple psychotropic drugs, also have a high incidence of prediabetes.
Symptoms: Prediabetes is often asymptomatic and suspicion often rests solely on risk factors mentioned above. If present, the symptoms of prediabetes, are the same as those of diabetes: constant hunger, increased thirst and urination, unexplained weight loss, weight gain, generalized malaise, blurred vision, slow healing from minor wounds like cuts and bruises, tingling or loss of sensation in the hands or feet, frequent or recurring gum, skin, vaginal or bladder infections.
How do you treat? The call for early treatment of prediabetes is gaining momentum. Several recent studies have evaluated the role of life-style changes and medications for the treatment of this malady:
1. Exercise: Regular physical activity prevents progression into diabetes. In the Da Qing IGT and Diabetes Study of 110,660 men and women in China( Diabetes Care 1997;20:537-44.), progression to diabetes decreased from 67.7% to 41.1%, when comparing an uncontrolled group to a controlled exercise group over a period of 6 years.
2. Diet: In a Finnish study (N Engl J Med 2001;344:1343-50), there was an incidence of 23% of progression into diabetes in a control group compared to only 11% in an intervention group over a period of 4 years. Interventions were aimed at reducing weight 5% or more, reducing dietary fat to less than 30% of the total caloric intake and increasing dietary fiber to at least 15g per 1000 calories ingested.
3. In al large study involving 27 clinical centers around the US(N Eng J Med, February 7, 2002),3234 prediabetic overweight participants were divided into two groups. One group received intensive training in diet, physical activity, and behavior modification. The aim was to reduce body weight by 7% and maintain the loss, and exercise 150 minutes a week. The second group received metformin 850 mg twice a day. At the end of the study, the lifestyle intervention group reduced diabetes progression by 58% compared to 31% in the metformin group.
4. A prediabetes task force (American Association of Clinical Endocrinologists 18th Annual Meeting, Houston,Tx. 2009) suggested a more aggressive therapeutic approach to these patients, recommending treating high-risk individuals with diabetic medications such as metformin, acarbose, glucagon-like peptide 1 agonists and thiazolidinediones. These treatments are not yet FDA approved for prediabetes, but are backed by strong scientific data indicating that battling insulin resistance early protects the pancreas and prevents progression into diabetes.
The health and monetary costs of prediabetes are not known. But diabetes is an expensive disease, costing about $174 b billion annually in the US alone. Direct medical costs account for about $116 billion and indirect costs such as disability payments, time lost from work, and premature death account for the remaining $58 billion.
Millions of lives and billions of dollars can be saved by aggressive life-style and therapeutic intervention in patients suffering from prediabetes.
Remember: Prediabetes means preceding diabetes. But it also means preventable diabetes.
Dr. Shashi K. Agarwal is a Board Certified Internist and Cardiologist with a private practice in New York City and New Jersey. He is also a diplomat of the American Board of Holistic Medicine and the American Academy of Anti-Aging Medicine.
By Shashi Agarwal MD
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