April 2015

By Ulupi Choksi, , M.D., Endocrinology, 2015 President, American Diabetes Association

We in the medical community, have focused on the diabetes epidemic that we have been facing over the last several years, yet not much light has been shed on the fact that for every person with diabetes there are approximately three people with Prediabetes, waiting to progress to diabetes. This valuable information can be used to address pertinent issues with many we see daily, as I recommend we bring this issue to the surface in its value of preventive & patient care.

In the United States at the present time, it is estimated that we have approximately 79 million people with Prediabetes. In absence of any inter vent ion, approximately 5- 6% of these people will develop diabetes each year. Think of the power we have once intervention is admitted into lifestyles of these people. By focusing on simple lifestyle inter vent ions and use of certain me dications , we can delay the onset of full blown diabetes and many complications that follow in its presence.

What is Prediabetes? In 1997 and 2003, the Expert Committee on Diagnosis and Classification of Diabetes Mellitus defined Prediabetes. During natural progression of Metabolic Syndrome with Insulin Resistance, Prediabetes is intermediary stage between “Normal” & “Diabetes”.

Prediabetes is the term used for individuals with impaired fasting glucose (IFG- fasting glucose between 100 mg/dL to 125 mg/dL) and/or impaired glucose tolerance (IGT) - and/or Hemoglobin A1C between 5.7 to 6.4%). This indicates an increased risk for future development of diabetes.

Usually Prediabetes is associated with obesity, especially abdominal or visceral obesity, dyslipidemia with high triglycerides and/or low HDL cholesterol and hypertension. Constellation of these in a person with Prediabetes increases their cardiovascular risk tremendously.

Good News!! Type 2 Diabetes can be prevented!

Several high-quality randomized trials show that lifestyle changes to diet and exercise can lead to substantial reductions in the incidence of the type 2 diabetes in persons with “Prediabetes”. These programs achieved modest weight loss (generally 5- 7% of body weight) but were markedly effective. Medications may be indicated for those who cannot achieve lifestyle goals.

“In a randomized, unblended, controlled trial of 522 overweight Finnish patients with impaired glucose tolerance (mean age, 55 years), an intervention aimed at a 5% reduction in weight decreased the incidence of newly diagnosed type 2 diabetes over 3 years, from 23% to 11%, The intervention involved personal counseling sessions to encourage a reduction in total and saturated fat intake to less than 30% and 10% of energy consumed, respectively; an increase in fiber intake; and moderate exercise for at least 30 minutes per day.”

“The Diabetes Prevention Project, a randomized, controlled trial that involved 3234 U.S. patients with Prediabetes (mean age, 51 years; mean body mass index, 34 kg/m 2), showed that a lifestyle modification program aimed at a 7% weight loss reduced the cumulative incidence of diabetes over 3 years, from 29% to 14% (relative risk [RR], 0.42 [C1, 0.34- 0.52]) compared with placebo. Ten-year follow-up found persistence of the initial effect of lifestyle, although after the study period the rates in the lifestyle and placebo groups were similar, implying that the intervention must be maintained for benefit to continue.”

“A randomized, controlled trial that involved 577 Chinese adults with impaired glucose tolerance assigned diet, exercise, both, or neither found that the incidence of diabetes over 6 years was 68% among persons in the “neither” group, 44% in the diet group, 41% in the exercise group, and 46% in the “both” group. All 3 interventions resulted in statistically significant reductions in the progression to diabetes.”

In our daily practice, we need to identify high risk patients with Prediabetes and counsel them towards a healthy diet, exercise, and minimal or moderate weight loss. Explaining “Prediabetes” as a window of opportunity to modify future health issues will appeal to our patients. We can encourage a brighter future for both patients and their families by addressing preventative care in delaying diabetes.

Advantages of healthier lifestyles and moderate weight loss, will not only benefit one patient but the lives’ of many (reaching out to friends & family members) beyond any risk of diabetes & Cardiovascular Disease- if only we can convince our patients to get on board & see the light!

Through our efforts in facilitating our patients with & without Prediabetes, we can assist them in achieving their personal goals and maintaining a healthier lifestyle for all! I encourage my peers to educate their patients, overseeing our responsibility as healthcare givers. All on board.