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Check Your Health is a new web-only feature being offered monthly by The Cheshire Herald. Each month, a professional from MidState Medical Group will offer advice on a different issue pertaining to health.
Prediabetes is when blood glucose levels are higher than normal but not high enough to be diagnosed as diabetes. It is also referred to as borderline diabetes, impaired glucose tolerance and/or impaired fasting glucose.Before people develop type 2 diabetes, they are first in a prediabetic state. According to national diabetes data from 2011, about 26 million have diabetes and 79 million people in the United States have prediabetes. If left untreated, diabetes can progress and lead to serious long term complications such as heart disease, stroke, nervous system and kidney damage, blindness, foot ulcers and amputation. Prediabetes increases the risk for heart disease, such as heart attack and stroke. Most people with prediabetes do not have any symptoms and by the time they are symptomatic, the condition has progressed to diabetes.
Cause of Prediabetes: Insulin resistance, a condition in which the body cells do not use insulin properly. Insulin helps cells use blood glucose for energy.
Who should get tested for prediabetes: In individuals without risk factors for diabetes, testing should begin at the age of 45 years old and even earlier in those with increased risk. Risk factors for diabetes include being overweight with a body mass index equal to or greater than 25kg/m2, family history of diabetes in a first degree relative, physical inactivity, history of gestational diabetes or having a baby weighing nine pounds or more at birth, high blood pressure, vascular disease, polycystic ovarian syndrome, metabolic syndrome, high cholesterol and high risk ethnic groups such as Asian-American, African American, Hispanic, Native American and Pacific Islanders.
Screening tests: There are three different tests to determine if you have prediabetes:
Fasting plasma glucose - This blood test is done after fasting overnight or at least eight hours. A blood level between 100-125mg/dl is considered prediabetes or impaired fasting glucose; 126mg/dl and above is diabetes.
Oral glucose tolerance test - Here, blood glucose is checked in a fasting state and again 2 hours after drinking a 75gram glucose rich drink. Two hour blood glucose values between 140-199mg/dl is considered prediabetes or impaired glucose tolerance, while 200mg/dl and above is indicative of diabetes.
Glycosylated hemoglobin/A1c test - This blood test gives the average amount of glucose in the blood over past the three months. It is very convenient as it does not require fasting. Values between 5.7-6.4% are considered prediabetes, whereas 6.5% and above is diagnostic of diabetes. Certain conditions can make the A1c test inaccurate, such as pregnancy or having an uncommon form of hemoglobin.
The diagnosis of diabetes must be confirmed by repeating the test which was abnormal on another day for confirmation. Higher values convey higher risk than lower values. If the tests are normal, it should be repeated in three years, but for those that have increased risk for diabetes, the test should be performed yearly.
Management of prediabetes/Prevention of progression to diabetes:
Approximately 25 percent of people with prediabetes progress to diabetes over 3-5 years. A diabetes prevention program study has shown that people with prediabetes can prevent the development of type 2 diabetes by making changes in their diet and increasing their level of physical activity. They may even be able to return their blood glucose levels to the normal range.
The American Diabetes Association recommends lifestyle modification as the primary intervention. Research shows risk for type 2 diabetes can be lowered by 58 percent by lifestyle modification. That is, smoking cessation, diet control, weight loss of 5-10 percent of body weight, moderate intensity exercise of thirty minutes daily for at least five days a week, such as brisk walking. The thirty minute exercise can be split into smaller sessions if it cannot be done at one time. Drug therapy may be helpful in preventing type 2 diabetes in high risk patients in whom lifestyle interventions fail or are not sustainable.
The American Diabetes Association also recommends consideration of metformin for diabetes prevention in individuals at highest risk for developing diabetes, such as those with both impaired fasting glucose and impaired glucose tolerance and are younger than 60 years of age and with a body mass index equal to or greater than 35kg/m2 or who have additional risk factors such as a family history in first a degree relative, elevated triglycerides, reduced HDL, high blood pressure and A1C greater than 6.0 percent.
While studies have shown that drug therapy may delay the development of diabetes, lifestyle changes work better and are twice as effective as taking a pill.
Benish Hussain, MD
Internal Medicine, Board Certified
Midstate Medical Group, Women’s Primary Care