Pre-Diabetes A Health Warning, Experts Say

Federal Health Officials Begin New Prevention Efforts

Forty-one million Americans have blood sugar levels high enough to put them at risk of developing diabetes - more than twice the previous estimate.

The new number means two of every five adults ages 40 to 74 is now considered to have pre-diabetes, the US Department of Health and Human Services (HHS) reports.

"These latest numbers show how urgent the problem really is," says HHS Secretary Tommy Thompson. "We need to help Americans take steps to prevent diabetes or we will risk being overwhelmed by the health and economic consequences of an ever-growing diabetes epidemic."

About 18 million people in the US have diabetes, with 1.3 million new cases diagnosed every year.

Most people have type 2 diabetes, which is a result of the body's inability to make enough, or to properly use, insulin. Insulin is a hormone manufactured by the pancreas, which helps glucose leave the blood and enter the muscles and other tissues of the body.

Diabetes is a leading cause of heart disease, blindness, kidney failure and amputations, causing more than 200,000 deaths in the US every year.

Pre-diabetes "puts someone at risk not only of diabetes but also of heart attack and stroke," says Dr. Linda S. Geiss, chief of diabetes surveillance at the Centers for Disease Control and Prevention (CDC).

There are no agreed-upon estimates of the percentage of people with pre-diabetes who will develop the full-blown disease, Dr. Geiss says. But it is known that "taking preventive measures can return a pre-diabetic person to normal," she says. Those measures include proper nutrition and exercise.

Pre-diabetes can be diagnosed by the "impaired glucose tolerance" test, which measures blood sugar levels before eating anything in the morning.

Until last November, a level below 110 milligrams of glucose per deciliter of blood was described as normal. The new guideline lowers the bar, so a reading of 100 or higher classifies someone as pre-diabetic.

The new estimate comes from applying that standard to data from the latest National Health and Nutrition Examination Survey, Dr. Geiss said.

The American Diabetes Association (ADA) is using the new guideline to call for what it says are relatively simple lifestyle changes to reduce the risk of developing diabetes.

"The biggest drivers include the high prevalence of obesity, which in turn is driven by exercise habits and diet habits," says Dr. Gene Barrett, president of the ADA and professor of medicine at the University of Virginia.

Adults should be doing the minimum amount of exercise recommended by many health organizations - 30 minutes of moderate activity at least three days a week, Dr. Barrett says. They also should avoid "high-calorie, high-density foods," he said.

Parents also should be looking after their children, with an eye not only toward having them exercise regularly but also "the easy availability of soft drinks and fast foods in school meal programs," Dr. Barrett said.

Losing just 5 percent of body weight - 10 pounds for a 200-pound adult - can move someone out of the pre-diabetic state into better health, he says.

Always consult your physician for more information.

Dick Clark Describes Diabetes Experience

Tan, fit, and still youthful at 74, TV legend Dick Clark hardly looks like a poster boy for type 2 diabetes.

So many were shocked when the long-time host of "American Bandstand" announced recently that he was diagnosed with diabetes more than 10 years ago.

The self-confessed workaholic believes that diabetes "shouldn't slow you down," and to prove it, he has embarked on a cross-country tour aimed at educating the public about the deadly links between diabetes and heart disease.

"Two-thirds of people who have diabetes die of either heart disease or stroke," Clark says. "That was enough for me to stand up and say 'Whoa, I'm in that group.' It just seemed like it was time to get out and shout about it."

That 'shouting' includes teaming up with the American Association of Diabetes Educators (AADE) for the launch of their new campaign Diabetes: Know the Heart Part, supported by pharmaceutical giant Merck & Co.

Speaking in his trademark baritone, Clark says he had not felt the need to tell the wider world about his 1994 diagnosis until recently because "I felt fine - no symptoms."

"I'm still on top of it," he adds.

Following his physicians' advice, Clark now exercises 20 minutes each day to keep his cardiovascular system in good shape.

For the first few years after his diagnosis, he says, "I just kept eating whatever I ate and cleaned the plate. But now I try and eat only good food, and less of it."

Clark is also on "all kinds of medication" to control his diabetes.

Diabetes greatly increases heart disease risk because chronic high blood sugar weakens blood vessels over time, increasing chances for blocked arteries, heart attack, and stroke.

Current guidelines from the ADA advise that diabetics stick to healthy diets and regular exercise programs that reduce their cardiovascular risk, and take cholesterol-lowering medications. Another group, the American College of Physicians, recently announced similar guidelines.

Always consult your physician for more information.

Online Resources

American Diabetes Association

American Heart Association

Centers for Disease Control and Prevention (CDC)

HealthierUS.Gov

National Diabetes Education Program

National Diabetes Information Clearinghouse

National Institute of Diabetes & Digestive & Kidney Diseases

National Institutes of Health (NIH)

National Library of Medicine

June 2004

Pre-Diabetes A Health Warning, Experts Say

Dick Clark Describes Diabetes Experience

Program Addresses Diabetes Threat

Online Resources

Other Resources:

Find a St. John's Mercy Physician

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Diabetes Health Information

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Program Addresses Diabetes Threat

Today HHS Secretary Tommy G. Thompson and the National Diabetes Education Program (NDEP) launched the first national multicultural diabetes prevention campaign, Small Steps. Big Rewards. Prevent type 2 Diabetes, to take action against the growing diabetes epidemic.

“We need to act urgently to confront the epidemic of type 2 diabetes that is threatening Americans, especially minority populations,” says Secretary Thompson. “There are effective steps that people can take for themselves to hold off the progression of type 2 diabetes. We need to reach Americans with the words and pictures that they understand to help them promote and protect their good health.”

In response to the diabetes epidemic, NDEP is taking the lead on delivering the type 2 diabetes prevention message to high risk audiences through its campaign targeted to multicultural and older adult audiences.

The campaign focuses on empowering people at high risk to make modest lifestyle changes that can prevent or delay the onset of type 2 diabetes.

Campaign materials include motivational tip sheets for consumers as well as print and radio public service ads. Each set of materials is specifically tailored for one of the high risk groups:

• African Americans
  
  
• Hispanic and Latino Americans
  
  
• American Indians and Alaska Natives
  
  
• Asian Americans and Pacific Islanders
  
  
• Adults ages 60 and older
  

“Diabetes is a growing epidemic in our communities, especially for these high risk groups,” said Dr. James R. Gavin III, chair of the NDEP and president of Morehouse School of Medicine. “If we are going to make a difference, we need to reach people where they live, work, and play, so we are partnering with community groups.

"We have consumer-friendly materials with practical advice in several languages," Dr. Gavin says. "This campaign provides the tools to help those hardest hit by this growing epidemic to prevent the disease and its serious, deadly complications.”

The rapid increase in people who are at risk for diabetes, and people with diabetes, is closely tracking the nation’s escalating obesity rates. Last month, the Centers for Disease Control and Prevention (CDC) released a study that showed that deaths due to obesity will soon overtake tobacco as the leading cause of death. Overweight and obesity are key risk factors for developing type 2 diabetes.

“People need to know if they have pre-diabetes or are at risk for developing type 2 diabetes,” said Dr. Allen M. Spiegel, director of the National Institute of Diabetes and Digestive and Kidney Diseases. “Talk to your health care provider about your risk. By taking small steps today, you can achieve a big reward - delaying or preventing type 2 diabetes.”

According to the NDEP, everyone over age 45 should consult with his or her health care provider about testing for pre-diabetes or diabetes. Those over 45 and overweight are strongly recommended for testing.

Those who are younger than 45, overweight, and who have one or more of the other risk factors could be at a high risk of developing type 2 diabetes and should also consult their health care provider about testing.

Risk factors for diabetes include:

• Age: risk increases with age
  
  
• Overweight: BMI (body mass index) 25 or higher (23 or higher if Asian American, 26 or higher if Pacific Islander)
  Blood pressure: 140/90 mm/Hg or higher
  
  
• Cholesterol: Abnormal lipid levels - HDL cholesterol less than 40mg/dL for men and less than 50 mg/dL for women; triglyceride level 250 mg/dL or higher
  
  
• Family history of diabetes: having a parent, brother, or sister with diabetes
  
  
• Ethnicity: African American, American Indian, Asian American, Pacific Islander, or Hispanic American/Latino heritage
  
  
• History of gestational diabetes: or giving birth to a baby weighing more than 9 pounds
  
  
• Inactive lifestyle: exercise fewer than three times a week
  

Always consult your physician for more information.