Four out of 10 Americans over age 20 and half of those over 65 have prediabetes, meaning that their blood sugar levels are modestly elevated, which can increase the risk of cardiovascular disease, cognitive impairment, and other health problems. Some good news is that prediabetes—also sometimes referred to as impaired glucose tolerance or impaired fasting glucose—is not yet full-fledged type 2 diabetes, which can have even more dire consequences.
Here’s even better news: Lifestyle changes can halt or at least delay progression of prediabetes to diabetes—and according to new clinical guidelines issued by an independent task force, community-based diet and exercise programs should be strongly recommended for people with prediabetes. As reported in the Annals of Internal Medicine, the panel, which reviewed 53 studies, concluded that such programs are effective in reducing weight and lowering the risk for diabetes, and that they can even help return blood sugar to normal levels.
These “evidenced-based” community programs—offered across the country at health clinics, Y’s, and other locations—provide structured guidance on healthy eating and encourage increased activity to help in weight loss. Led by dietitians, diabetes educators, nurses, exercise counselors, and other trained providers, small groups of people with prediabetes meet regularly over a period of several months to a year or more, with follow-up maintenance sessions also provided. Sometimes the programs are conducted remotely over the Internet, video links, or telephone.
To be eligible, participants must be overweight and meet the criteria for prediabetes—a fasting blood glucose level between 100 and 125 (normal is below 100, while over 125 is usually considered diabetes), an oral glucose tolerance test of 140 to 199 mg/dL, or a hemoglobin A1c level (a measure of long-term blood sugar control) between 5.7 and 6.4 percent—or have other diabetes risk factors.
Take action, take control
Everyone 45 and older should be tested for diabetes. But many people should be screened earlier, including those who have a family history of type 2 diabetes, belong to certain racial or ethnic groups (including blacks, Hispanics, Native Americans, and Asians), or have conditions associated with insulin resistance (such as hypertension, high cholesterol, or polycystic ovary syndrome).
If you are diagnosed with prediabetes and do nothing, there’s at least a 50 percent chance that you will develop diabetes within 10 years. But enrolling in a National Diabetes Prevention Program can stop the ticking clock. The CDC sets the standards for the programs and accredits them. You can locate one near you by visiting the CDC website, where you can also learn more about the risk factors for prediabetes and diabetes, take a prediabetes screening test, and see the program curriculum. The programs are often free, but if there is a cost (about $425), it may be covered by your insurance or employer. Legislation that would require coverage under Medicare is pending.
Bottom line: The steps that can help prevent diabetes (notably weight control, exercise, and a heart-healthy diet) will also help prevent other health problems—and will help you control diabetes if you are ever diagnosed with it.