Prediabetes: A chance to change the future
Prediabetes: A chance to change the future Type 2 diabetes is defined as a fasting plasma glucose level of 7.0 mmol/L or higher. A fasting plasma glucose -*test*-('") is a method for finding out how much glucose or sugar is in the blood. The -*test*-('") can show if a person has diabetes, and is usually done in the morning before the person has eaten. However, the risks associated with rising levels of glucose in the blood are also important, even before they reach that point. “Prediabetes” or blood glucose levels that are near but not quite at the level that defines a diabetes diagnosis can also have serious health consequences. People with these elevated levels, called impaired glucose tolerance (IGT) or impaired fasting glucose (IFG), are at increased risk for developing diabetes and its complications over time. Not everyone in this category will progress to diabetes. In fact, some will revert to normal levels. Unfortunately, many will eventually develop diabetes, so identifying people who have prediabetes is important. This is especially true for those who have prediabetes as part of the “metabolic syndrome”, meaning they also have higher blood pressure, higher cholesterol and triglycerides, lower levels of HDL (the “good” cholesterol), and a tendency to abdominal obesity. The good news is that the rising glucose levels in prediabetes – along with most of these other aspects of the metabolic syndrome – can be reduced to normal levels, often without medication. Blood glucose can be reduced by simple lifestyle modifications, including exercise, and a healthy, low-fat meal plan. That lifestyle changes can actually prevent progression to diabetes has now been proven in two large studies, the Finnish Diabetes Prevention Study, and the Diabetes Prevention Program. Both of these studies showed that dietary modification targeting a low-calorie meal plan with reduced fat intake, and moderate-intensity physical activity of at least 150 minutes per week, resulted in a 58% reduction in the number of those who progressed from prediabetes to diabetes over the next four years, even though weight loss was modest. For those in whom lifestyle changes are not enough to normalize blood glucose, at least two medications have been shown to be effective in preventing progression to type 2 diabetes in people with IGT or prediabetes. These are metformin, proven effective in the DPP trial, which also studied lifestyle intervention, and acarbose, shown effective in another trial, the STOP-NIDDM study. Like type 2 diabetes, people can have prediabetes without knowing it, so being aware of your risk and being -*test*-('")ed are important. The risk for diabetes is higher as we grow older, so the Canadian Diabetes Association recommends screening for diabetes by -*test*-('")ing fasting plasma glucose for everyone once they reach the age of 40, and every three years after that. More frequent -*test*-('")ing, or an earlier start to regular screening, should be considered for those who have risk factors that increase the likelihood they may develop type 2 diabetes. These risk factors include: • Having a first-degree relative who already has diabetes. • Being a member of a high-risk population, such as those of Aboriginal, Hispanic, Asian, South Asian, or African descent. • Having a history of IGT, IFG or prediabetes. • Having already some evidence of the complications of diabetes such as eye, nerve or kidney problems. • Having heart disease. • Having a history of gestational diabetes mellitus. • Having high blood pressure or high cholesterol. • Being overweight, especially abdominal obesity. The important thing to remember about prediabetes is that it doesn't always lead to diabetes. Determining whether or not you have it gives you a chance to change the future – to one that does not include type 2 diabetes.
Prediabetes: A chance to change the future Type 2 diabetes is defined as a fasting plasma glucose level of 7.0 mmol/L or higher. A fasting plasma glucose -*test*-('") is a method for finding out how much glucose or sugar is in the blood. The -*test*-('") can show if a person has diabetes, and is usually done in the morning before the person has eaten. However, the risks associated with rising levels of glucose in the blood are also important, even before they reach that point. “Prediabetes” or blood glucose levels that are near but not quite at the level that defines a diabetes diagnosis can also have serious health consequences. People with these elevated levels, called impaired glucose tolerance (IGT) or impaired fasting glucose (IFG), are at increased risk for developing diabetes and its complications over time. Not everyone in this category will progress to diabetes. In fact, some will revert to normal levels. Unfortunately, many will eventually develop diabetes, so identifying people who have prediabetes is important. This is especially true for those who have prediabetes as part of the “metabolic syndrome”, meaning they also have higher blood pressure, higher cholesterol and triglycerides, lower levels of HDL (the “good” cholesterol), and a tendency to abdominal obesity. The good news is that the rising glucose levels in prediabetes – along with most of these other aspects of the metabolic syndrome – can be reduced to normal levels, often without medication. Blood glucose can be reduced by simple lifestyle modifications, including exercise, and a healthy, low-fat meal plan. That lifestyle changes can actually prevent progression to diabetes has now been proven in two large studies, the Finnish Diabetes Prevention Study, and the Diabetes Prevention Program. Both of these studies showed that dietary modification targeting a low-calorie meal plan with reduced fat intake, and moderate-intensity physical activity of at least 150 minutes per week, resulted in a 58% reduction in the number of those who progressed from prediabetes to diabetes over the next four years, even though weight loss was modest. For those in whom lifestyle changes are not enough to normalize blood glucose, at least two medications have been shown to be effective in preventing progression to type 2 diabetes in people with IGT or prediabetes. These are metformin, proven effective in the DPP trial, which also studied lifestyle intervention, and acarbose, shown effective in another trial, the STOP-NIDDM study. Like type 2 diabetes, people can have prediabetes without knowing it, so being aware of your risk and being -*test*-('")ed are important. The risk for diabetes is higher as we grow older, so the Canadian Diabetes Association recommends screening for diabetes by -*test*-('")ing fasting plasma glucose for everyone once they reach the age of 40, and every three years after that. More frequent -*test*-('")ing, or an earlier start to regular screening, should be considered for those who have risk factors that increase the likelihood they may develop type 2 diabetes. These risk factors include: • Having a first-degree relative who already has diabetes. • Being a member of a high-risk population, such as those of Aboriginal, Hispanic, Asian, South Asian, or African descent. • Having a history of IGT, IFG or prediabetes. • Having already some evidence of the complications of diabetes such as eye, nerve or kidney problems. • Having heart disease. • Having a history of gestational diabetes mellitus. • Having high blood pressure or high cholesterol. • Being overweight, especially abdominal obesity. The important thing to remember about prediabetes is that it doesn't always lead to diabetes. Determining whether or not you have it gives you a chance to change the future – to one that does not include type 2 diabetes.