Reversing prediabetes
Q. What is prediabetes and how do you know you have it? Can you keep it from turning into diabetes?
A. Prediabetes is defined as having blood sugar levels that are higher than normal but short of qualifying as diabetes. A study published in the April issue of American Journal of Preventive Medicine estimates that 30 percent of adults in the US have prediabetes, but more than 90 percent of those affected are unaware of it. The study found that only half of people diagnosed with prediabetes had taken steps to get healthier in the previous year.
Dr. Mary-Elizabeth Patti, an endocrinologist at Joslin Diabetes Center, says that several terms are used to describe related conditions: prediabetes, metabolic syndrome, impaired fasting glucose, and impaired glucose tolerance. Although the terminology can cause confusion, she says, “all of them are conditions associated with a higher risk of diabetes and cardiovascular disease.’’
Prediabetes is a stage along a path to diabetes, in which the body fails to respond to its own insulin. The pancreas tries to compensate by churning out more insulin, but eventually the system fails. There’s a growing recognition that this process can be slowed or reversed if caught early. One large study found that people with prediabetes could decrease their diabetes risk by 58 percent through modest weight loss and exercise.
A doctor can detect prediabetes by administering one of two tests: the fasting plasma glucose test (FPG) or the oral glucose tolerance test (OGTT). Risk factors for prediabetes include a family history of diabetes, a personal history of cardiovascular disease, high blood pressure, having had diabetes during pregnancy, and being overweight, particularly if the extra weight is in the abdomen. Certain ethnic groups, including Hispanics and African-Americans, are also at higher risk.
Patti says that a diagnosis of prediabetes or a related condition should be seen as a call to action. “It’s important not to wait until diabetes is diagnosed,’’ she says. The most effective strategy is to try to lose a small percentage of body weight in the context of regular exercise. In some cases, medications such as metformin can also help.
