Officials Step Up Efforts to Identify Those with "Pre-Diabetes" To Reverse Type 2 Diabetes Epidemic
BOSTON — April, 2002 — Increased efforts must be made to identify the estimated 16 million Americans who have "pre-diabetes" — a condition in which blood sugar levels are higher than normal but not high enough to be classified as full-blown diabetes, according to federal officials and those with the American Diabetes Association, and Joslin Diabetes Center. Those with pre-diabetes are at increased risk of developing type 2 diabetes within a decade unless they adopt a healthier lifestyle that includes weight loss and more exercise.
The recommendation announced by US Health and Human Services Secretary Tommy Thompson and other officials March 27 follows on the heels of the recently announced national type 2 diabetes prevention study. The Diabetes Prevention Program (DPP) study showed people with elevated blood sugar levels who are at risk for developing type 2 diabetes can reduce their risk by 58 percent through sustained modest weight loss and increased moderate-intensity exercise, such as walking 30 minutes daily.
What is 'Pre-diabetes'?
According to Edward Horton, MD, director of clinical research at Joslin Diabetes Center in Boston and head of the DPP study at Joslin, this latest announcement reflects two major new developments. "First, a new term, pre-diabetes, has been officially introduced to define a group of people who are at high risk of developing type 2 diabetes and also are at increased risk of developing heart disease," he said.
Among those who should be screened for pre-diabetes include overweight adults age 45 and older and those under age 45 who are significantly overweight and who have one or more of the following:
- family history of diabetes
- low HDL cholesterol and high triglycerides
- high blood pressure
- history of gestational diabetes or giving birth to a baby weighing over 9 pounds
- belong to a minority group, including African-Americans, Native Americas, Hispanic Americans, Asian Americans, Pacific Islanders
"Second, the American Diabetes Association has changed its position on recommended screening of high risk populations to diagnose pre-diabetes," Dr. Horton explained. Doctors use one of two tests to determine if a person has pre-diabetes. They can either use a blood test that measures fasting glucose, or an oral glucose tolerance test (OGTT), during which the blood sugar level is measured before and two hours after drinking a glucose-containing solution. Both tests require that a person fast 8 to 12 hours prior to testing. "Instead of recommending only a fasting blood glucose test, the ADA now is recommending a fasting glucose test OR a two-hour oral glucose tolerance test (OGTT). This will pick up more people at risk and hopefully help with preventive strategies," Dr. Horton said.
A normal fasting blood glucose is below 110 mg/dl. Those with pre-diabetes have Impaired Fasting Glucose (IFG), which is a fasting blood glucose level between 110-125 mg/dl; OR they have Impaired Glucose Tolerance (IGT), a fasting glucose of less than 126 mg/dl and a blood glucose level of 140-199 mg/dl two hours after drinking the glucose drink in the OGTT test. If the fasting blood sugar level rises to 126 mg/dl or above, or the two-hour value during the OGTT is 200 mg/dl or greater, the person has diabetes.
Dr Horton added: "The best screening test, in my opinion, is to do the two-hour OGTT, which gives both a fasting and a two-hour value. That is the testing we are doing when we screen people for Joslin's research studies. This is a free screening service for people who are at high risk for diabetes and who are interested in the possibility of volunteering for research studies." Click here to learn more about participating in a research study.
Those who should be screened include those who have been told by their doctors that they have "borderline diabetes" or Impaired Glucose Tolerance (IGT)," said Dr. Horton. "Until now, Impaired Fasting Glucose (IFG) has generally been ignored and considered normal by many physicians, although it is clearly a risk factor for developing diabetes."
Be sure to ask your doctor what your exact blood sugar test results are when he tells you that you have "borderline diabetes." Some physicians are not as familiar as they should be with the new national guidelines for diagnosing diabetes. They may be telling you that you have borderline diabetes, when in fact you have actual diabetes.
Making it Official
"The new joint position statement from the ADA and the National Institute for Diabetes, Digestive and Kidney Disease (NIDDK) allows an official recognition of people with pre-diabetes — that is Impaired Fasting Glucose and/or Impaired Glucose Tolerance — for testing and interventions. It also gives a 'condition' that then may get more interest in terms of research, public policy, and the like," Dr. Horton explained. The new recommendations also have economic implications, he added. "Currently, physicians can't bill and third party payers (health insurers) don't pay for diagnostic testing in these patients. The patients have to pay out of pocket. So insurers will now have to decide whether to cover pre-diabetes testing and interventions," he said. The details of the joint NIDDK-ADA announcement appear in the April issue of the journal, Diabetes Care.
In addition, the officials announced increased statistics on how many Americans are estimated to have diabetes. The figure was increased from 16 million to 17 million Americans, about 5.9 million of whom are undiagnosed. Of the estimated 16 million with pre-diabetes, the officials said studies have shown that most people will develop type 2 diabetes over the next decade.
