Info on
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
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).
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'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.
Tips on how
to include a healthy amount of physical activity into your daily routine:
Frequently Asked Questions: Exercise and Diabetes
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:
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