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[IP] ABOUT PRE-DIABETES



ABOUT PRE-DIABETES

Before people develop type 2 diabetes, they almost always have
"pre-diabetes" -- blood glucose levels that are higher than normal but
not yet high enough to be diagnosed as diabetes.  At least 16 million
people in the United States (15.6% of the population), ages 40 to 74,
have pre-diabetes.  Recent research has shown that some long-term damage
to the body, especially the heart and circulatory system, may already be
occurring during pre-diabetes.

But research has also shown that if you take action to control your
blood glucose when you have pre-diabetes, you can delay or prevent type
2 diabetes from ever developing.  The American Diabetes Association has
just published a Position Statement on "The Prevention or Delay of Type
2 Diabetes" to help guide health care professionals in treating their
patients with pre-diabetes.

There is a lot you can do yourself to know your risks for pre-diabetes
and to take action to prevent diabetes if you have, or are at risk for,
pre-diabetes.  The American Diabetes Association has a wealth of
resources for people with diabetes.  People with pre-diabetes can expect
to benefit from much of the same advice for good nutrition and physical
activity.  The links on this page are cornerstones of successful
management of pre-diabetes.

The scientific and medical basis for identifying pre-diabetes as a
serious health threat is laid out in a new Position Statement entitled
"The Prevention or Delay of Type 2 Diabetes".  The statement has been
issued jointly by the American Diabetes Association and the National
Institute of Diabetes and Digestive and Kidney Diseases.

 

HOW DO YOU TELL IF YOU HAVE PRE-DIABETES?

There are two different tests your doctor can use to determine whether
you have pre-diabetes: the fasting plasma glucose test (FPG) or the oral
glucose tolerance test (OGTT).  The blood glucose levels measured after
these tests determine whether you have a normal metabolism, or whether
you have pre-diabetes or diabetes.  If your blood glucose level is
abnormal following the FPG, you have impaired fasting glucose (IFG); if
your blood glucose level is abnormal following the OGTT, you have
impaired glucose tolerance (IGT).





 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

       FPG            



 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OGTT    

The American Diabetes Association Risk Test for Diabetes can help you
determine if you are at increased risk for diabetes or pre-diabetes.  A
high score may indicate that you have pre-diabetes or at risk for
pre-diabetes.   Take the test and find out for sure. 

WHAT YOU CAN DO

Pre-diabetes is a serious medical condition that can be treated.  The
good news is that the recently completed Diabetes Prevention Program
study conclusively showed that people with pre-diabetes 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.

While the DPP also showed that some medications may delay the
development of diabetes, diet and exercise worked better.  Just 30
minutes a day of moderate physical activity, coupled with a 5-10%
reduction in body weight, produced a 58% reduction in diabetes.

The American Diabetes Association is developing materials that will help
people understand their risks for pre-diabetes and what they can do to
halt the progression to diabetes and even to, "turn back the clock."  In
the meantime, ADA has a wealth of resources for people with diabetes or
at risk for diabetes that can be of use to people interested in
pre-diabetes.

NUTRITION

ADA's guide to the basics of eating healthy

ADA's statement for health care professionals on nutrition

The American Diabetes Association bookstore has award-winning books on
nutrition, recipes, weight loss, meal planning and more.

EXERCISE

Tips on how to include a healthy amount of physical activity into your
daily routine:

Exercise and Diabetes

Frequently Asked Questions: Exercise and Diabetes

Web Resource: Exercise

ADA's statement for health care professionals on exercise

You can get fit, reduce your risk for type 2 diabetes, and support the
American Diabetes Association by participating in America's Walk for
Diabetes. 

FREQUENTLY ASKED QUESTIONS

Q: What is pre-diabetes and how is it different from diabetes?

A: Pre-diabetes is the state that occurs when a person's blood glucose
levels are higher than normal but not high enough for a diagnosis of
diabetes. About 11 percent of people with pre-diabetes in the Diabetes
Prevention Program standard or control group developed type 2 diabetes
each year during the average 3 years of follow-up. Other studies show
that most people with pre-diabetes develop type 2 diabetes in 10 years.

Q: Is pre-diabetes the same as Impaired Glucose Tolerance or Impaired
Fasting Glucose?

A: Yes. Doctors sometimes refer to this state of elevated blood glucose
levels as Impaired Glucose Tolerance or Impaired Fasting Glucose
(IGT/IFG), depending on which test was used to detect it.

Q: Why do we need to give it a new name? Has the condition changed?

A: The condition has not changed, but what we know about it has. We are
giving IGT/IFG a new name for several reasons. Pre-diabetes is a clearer
way of explaining what it means to have higher than normal blood glucose
levels. It means you are likely to develop diabetes and may already be
experiencing the adverse health effects of this serious condition.
People with pre-diabetes are at higher risk of cardiovascular disease.
People with pre-diabetes have a 1.5-fold risk of cardiovascular disease
compared to people with normal blood glucose. People with diabetes have
a 2- to 4-fold increased risk of cardiovascular disease. We now know
that people with pre-diabetes can delay or prevent the onset of type 2
diabetes through lifestyle changes.

Q: How do I know if I have pre-diabetes?

A: Doctors can use either the fasting plasma glucose test (FPG) or the
oral glucose tolerance test (OGTT) to detect pre-diabetes. Both require
a person to fast overnight. In the FPG test, a person's blood glucose is
measured first thing in the morning before eating. In the OGTT, a
person's blood glucose is tested after fasting and again 2 hours after
drinking a glucose-rich drink.

Q: How does the FPG test define diabetes and pre-diabetes?

A: Normal fasting blood glucose is below 110 mg/dl. A person with
pre-diabetes has a fasting blood glucose level between 110 and 125
mg/dl. If the blood glucose level rises to 126 mg/dl or above, a person
has diabetes.

Q: How does the OGTT define diabetes and pre-diabetes?

A: In the OGTT, a person's blood glucose is measured after a fast and 2
hours after drinking a glucose-rich beverage.

Normal blood glucose is below 140 mg/dl 2 hours after the drink. 

In pre-diabetes, the 2-hour blood glucose is 140 to 199 mg/dl. 

If the 2-hour blood glucose rises to 200 mg/dl or above, a person has
diabetes. 

Q: Which test is better?

A: According to the expert panel, either test is appropriate to identify
pre-diabetes.

Q: Why do I need to know if I have pre-diabetes?

A: If you have pre-diabetes, you can and should do something about it.
Studies have shown that people with pre-diabetes can prevent or delay
the development of type 2 diabetes by up to 58 percent through changes
to their lifestyle that include modest weight loss and regular exercise.
The expert panel recommends that people with pre-diabetes reduce their
weight by 5-10 percent and participate in some type of modest physical
activity for 30 minutes daily. For some people with pre-diabetes,
intervening early can actually turn back the clock and return elevated
blood glucose levels to the normal range.

Q: Will my insurance cover testing and treatment?

A: Because all insurance plans are different, this is a difficult
question to answer. However, Medicare and most insurance plans cover
diabetes testing for people suspected of having diabetes. People at risk
for diabetes are also at risk for pre-diabetes. Since the test is the
same and the risk factors are the same for both conditions, a
pre-diabetes test may be covered. It is best to consult your physician
and health insurance representative with specific coverage questions.

Q: What is the treatment for pre-diabetes?

A: Treatment consists of losing a modest amount of weight (5-10 percent
of total body weight) through diet and moderate exercise, such as
walking, 30 minutes a day, 5 days a week. Don't worry if you can't get
to your ideal body weight. A loss of just 10 to 15 pounds can make a
huge difference. If you have pre-diabetes, you are at a 50 percent
increased risk for heart disease or stroke, so your doctor may wish to
treat or counsel you about cardiovascular risk factors, such as tobacco
use, high blood pressure, and high cholesterol.

Q: Who should get tested for pre-diabetes?

A: If you are overweight and age 45 or older, you should be tested for
pre-diabetes during your next routine medical office visit. If your
weight is normal and you're over age 45, you should ask your doctor
during a routine office visit if testing is appropriate. For adults
younger than 45 and overweight, your doctor may recommend testing if you
have any other risk factors for diabetes or pre-diabetes. These include
high blood pressure, low HDL cholesterol and high triglycerides, a
family history of diabetes, a history of gestational diabetes or giving
birth to a baby weighing more than 9 pounds, or belonging to an ethnic
or minority group at high risk for diabetes.

Q: How often should I be tested?

A: If your blood glucose levels are in the normal range, it is
reasonable to be retested every 3 years. If you have pre-diabetes, you
should be tested for type 2 diabetes every 1-2 years after your
diagnosis.

Q: Could I have pre-diabetes and not know it?

A: Absolutely. People with pre-diabetes don't often have symptoms. In
fact, millions of people have diabetes and don't know it because
symptoms develop so gradually, people often don't recognize them. Some
people have no symptoms at all. Symptoms of diabetes include unusual
thirst, a frequent desire to urinate, blurred vision, or a feeling of
being tired most of the time for no apparent reason.

Q: Should children be screened for pre-diabetes?

A: We are not recommending screening children for pre-diabetes because
we don't have enough evidence that type 2 diabetes can be prevented or
delayed in children at high risk for the disease. However, a study
published in the March 14, 2002, issue of the New England Journal of
Medicine found 25 percent of very obese children and 21 percent of very
obese adolescents had pre-diabetes. If future studies show that early
intervention also works for children, a recommendation could be
forthcoming.

 

 

 

 

 

 

 

 

 

 

 

 

 

 All your weight loss questions are answered in 101 Weight Loss Tips for
Preventing and Controlling Diabetes, which was written by three experts
in the field of nutrition and diabetes. Being overweight puts you at
risk of getting diabetes and other health problems. Losing weight can
save you more than money and make you look better inside and out.

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