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Diabetes Special Report

Prediabetes: Meeting an Epidemic With New Treatment Goals

The numbers are staggering: About 57 million Americans, or at least one in four adults, have prediabetes. All of these people are at increased risk for type 2 diabetes and the complications associated with it, including coronary heart disease (CHD) and stroke. Until recently, no clear standards indicated how to manage prediabetes. But now, there are specific guidelines for treating prediabetes sooner and more intensively, well before it progresses to diabetes. Here’s what you should know.

Diabetes and prediabetes:
Type 2 diabetes occurs when muscle, liver, and fat cells don't respond to insulin, when the pancreas doesn't produce enough insulin, or both. Insulin helps cells metabolize glucose, a simple sugar that all cells need for energy. When glucose is poorly metabolized, cells starve and sugar builds up in the bloodstream, causing hyperglycemia (high blood sugar). Chronic hyperglycemia leads to a variety of problems, including kidney, eye, and nerve damage; foot and skin infections; and cardiovascular disease.

Diabetes can be diagnosed with a fasting plasma glucose (FPG) test, which measures blood glucose after an overnight fast. In addition, doctors may use an oral glucose tolerance test (OGTT), which measures blood glucose two hours after ingestion of a standard amount of glucose. An OGTT indicates how well insulin clears glucose from the bloodstream.

Prediabetes is defined by elevated glucose values on either test. According to the American Diabetes Association (ADA), patients with glucose levels of 100–125 mg/dL on a FPG test or 140–200 mg/dL on an OGTT have prediabetes. Higher glucose levels define diabetes. Most people with prediabetes go on to develop diabetes. Approximately 11% are diagnosed with diabetes within three years; more than half have diabetes within 10 years.

Recently a task force of experts issued a set of guidelines for people diagnosed with prediabetes. Acting on the new guidelines, the ADA now recommends the same cardiovascular treatment goals for prediabetes as for diabetes. These goals include:

  • LDL cholesterol levels below 100 mg/dL
  • HDL cholesterol levels greater than 50 mg/dL for women and 40 mg/dL for men
  • Triglyceride levels below 150 mg/dL
  • Blood pressure under 130/80 mm Hg
  • low-dose aspirin

What you can do if you have prediabetes:

  • The first step is lifestyle changes, including exercising and eating a healthy diet (fruits and nonstarchy vegetables, lean meats, and nonfat dairy products, for instance). Results from the Diabetes Prevention Program study found that people with prediabetes who lost about 10% of their body weight and exercised regularly (30-60 minutes, five days per week) were 71% more likely to prevent or at least delay diabetes than those who didn't.
  • People with prediabetes should not smoke and should also avoid excessive alcohol consumption (which means no more than one drink each day for women and two drinks for men).
  • Many people will need extra help -- like a statin to lower LDL ("bad") cholesterol or blood pressure medications like diuretics or ACE inhibitors.
  • If weight loss and exercise don't keep glucose in check, your doctor may also consider a diabetes drug, but only as a last resort. Research shows that drugs like metformin (Glucophage) or acarbose (Precose) can delay the onset of type 2 diabetes in people with prediabetes -- but not nearly as effectively as lifestyle changes. None of these drugs is approved to treat prediabetes, and some carry serious side effects.

Getting tested for prediabetes:
Most people with prediabetes don't know they have it. According to the ADA, screening for prediabetes is recommended for all adults 45 and older. Testing should also be done on younger people who are overweight (defined as a body mass index greater than 25) and have additional risk factors, including cardiovascular disease, hypertension, high triglyceride or low HDL ("good") cholesterol levels, a sedentary lifestyle, nonwhite race, or a family history of diabetes. Women who delivered a baby weighing more than 9 lbs or who were diagnosed with gestational diabetes should be screened as well.

Posted in Diabetes on May 20, 2010

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