July 2, 2018

Fighting the prediabetes epidemic


Prediabetes means blood sugar is above normal. Here’s what to know to prevent this from becoming full-blown diabetes.

Prediabetes affects 86 million American adults. That’s more than one out of three people. Most people – nine out of 10 – who have prediabetes don’t know they have it.

Prediabetes means that someone’s blood sugar levels are higher than normal, but not high enough to be diagnosed as diabetes. Although usually a fasting blood glucose or A1C test (a blood test that measures average blood sugar level for several months) is used for diagnosis, a prediabetes diagnosis can come from bloodwork typically done during a physical. Often, there are no symptoms at this stage.

We can fairly call prediabetes an epidemic, meaning it is widespread. There are more undiagnosed cases than diagnosed cases, and numbers continue to rise. In Tennessee, part of the “diabetes belt” that runs through much of the South, 11.7 percent of the population had diabetes as of 2014. Nationally, about 9.3 percent of the U.S. population has diabetes.

While weight is not the only risk factor, it is an important one.

“Unfortunately, in the South, physical inactivity is common, especially among those who are overweight,” said Elaine Boswell King, quality coordinator of Diabetes Self-Management Education services at the Vanderbilt Eskind Diabetes Clinic. “Many who live in the South still fry foods and cook with bacon grease. Also, many people don’t think about portion sizes or the amount of food they are eating. And they don’t move around much during the day or after getting home from work.”

Dreary news? Hang on. There’s hope.

How to prevent or delay type 2 diabetes

The National Institutes of Health led a nationwide randomized study of 3,234 people who were overweight and diagnosed with prediabetes. Published in 2002, the study showed that even modest weight loss and exercise dramatically reduced their chances of developing diabetes.

“We are really in a good place in 2018 as we have this significant study that shows a 7 percent loss of body weight and changes in physical activity can lower a person’s risk of developing type 2 diabetes by 58 percent. Lifestyle changes for participants in Diabetes Prevention Programs recognized by the CDC, reduces risk by 71 percent,” said Boswell King. For example, if a person who weighs 200 pounds person loses just 10 to 14 pounds, that’s a game changer in terms of lowering the chance of developing diabetes.

“We can prevent or delay the onset of type 2 diabetes,” Boswell King said. “We want to get the occurrence of type 2 diabetes down. Then we’ve prevented a disease. Once you have diabetes, it does not go away. That’s why it is such a big deal to take action when you learn you have prediabetes. Learn how to lose weight through healthy eating and physical activity to prevent diabetes.”

Manageable ways to add activity

The research shows that changing habits makes a big difference, she said. To that end, CDC-recognized lifestyle-change programs provide trained coaches and use a CDC-approved curriculum to help people with a prediabetes diagnosis. Some of these effective programs are covered by employer-sponsored health plans and by some Medicare and Medicaid plans.

For example, the YMCA offers a 16-session, yearlong program at four Middle Tennessee sites: downtown Nashville, Franklin Family, Margaret Maddox and Maryland Farms. Several prevention programs are also offered at medical centers in Middle Tennessee.

Whether you enroll in one of these programs or not, Boswell King suggests manageable ways to incorporate more activity. If you sit for long periods, get up every 30 minutes for a stretch, do shoulder rolls or walk in place. Work regular walking into your day. You don’t even need a long walk, though those are a good thing. There are many ways to sneak short walks into your day.

“Take the stairs, walk in from the parking garage or take 10 minutes of your lunch break to walk around the building,” Boswell King said.

Are you at risk for diabetes?

Besides being overweight, another risk factor is age — we are more likely to have diabetes the older we get. If you are older than 45, ask your primary care provider for a blood glucose test.

Some other risk factors:

  • A family history of the disease.
  • Being African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, Native Hawaiian or Pacific Islander.
  • Having a baby weighing more than 9 pounds.
  • Having high blood pressure.
  • Being physically inactive.
Woman prepares breakfast in the kitchen

To schedule an appointment at the Eskind Diabetes Center, call 615-343-8332 for adult care and 615-322-7842 for children’s care.