BOSTON — November 22, 2002 — Now that national and international clinical research have demonstrated that the risk of developing type 2 diabetes can be reduced by more than half by altering diet and increasing physical activity to promote weight loss, it's more important than ever that people with "pre-diabetes” be identified.

“It is estimated that 16 million Americans, including an increasing number of young people, have pre-diabetes, a condition in which blood sugar levels are higher than normal, but not high enough for a diabetes diagnosis,” said Alan Moses, M.D., chief medical officer at Joslin Diabetes Center in Boston and Professor of Medicine at Harvard Medical School.

“People who have pre-diabetes are at increased risk of developing type 2 diabetes within 10 years if they don’t lose weight and increase the amount of physical activity they do each day. They also are at increased risk of developing heart disease, which is a frequent complication of diabetes,” said Dr. Moses.

The recently completed nationwide Diabetes Prevention Program conducted at Joslin and other institutions showed that people with pre-diabetes can reduce their risk of developing diabetes by 58 percent if they lose a modest amount of weight and begin a program of 30 minutes of physical activity daily.

Who Is at Risk?

"We at Joslin want to raise the public’s awareness of the diabetes epidemic," said Dr. Moses. "We want to let people know that if they have a history of diabetes in their family, come from certain high-risk ethnic groups, or have other diabetes risk factors, they should ask their doctor to be tested at regular intervals."

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
• previously identified Impaired Glucose Tolerance (IGT) or Impaired Fasting Glucose (IFG)
• history of gestational diabetes or giving birth to a baby weighing over 9 pounds
• Polycystic Ovary Disease
• belong to a minority group, including African-Americans, Native Americans, Latino/Hispanic Americans, Asian Americans, and Pacific Islanders

What Tests Are Used?

Your doctor or healthcare provider will use one of two tests to determine if you have pre-diabetes. He or she will use either 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 not eat for 8 to 12 hours prior to testing.

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.

“Be sure to ask your doctor what your exact blood sugar test results are when he or she tells you that you have "pre-diabetes." Some doctors are not as familiar as they should be with the new guidelines for diagnosing diabetes. They may be telling you that you have pre-diabetes, when in fact you have actual diabetes,” Dr. Moses said.

“The good news is that even if you are at risk for developing type 2 diabetes, you can do something about it to significantly reduce your risk through sustained modest weight loss and increased moderate-intensity physical activity, such as walking 30 minutes a day,” he said.

To learn more:

• Joslin’s new Latino Diabetes Initiative and clinic program to target those with diabetes and pre-diabetes.
• Joslin’s recently funded program to target African Americans hard hit by the diabetes epidemic.
• Joslin’s new program designed to target the rapid increase in diabetes among Asian Americans.
• Diabetes at a Glance fact sheet. Who is at risk?