As Diabetes Becomes a Growing Concern, a Consensus Is Developing for Assertive Treatment of Pre-Diabetes

Routine administration of the A1c test to patients to detect abnormal levels of glucose or glucose resistance is one of the five elements of this assertive approach to treating pre-diabetes.

Sep 4, 2008

With 21 million U.S. residents now officially diagnosed as having diabetes, healthcare professionals are looking at another statistic that is causing them many a sleepless night: The Centers for Disease Control estimate that there are 57 million people with pre-diabetes in the United States. (Pre-diabetes is defined as impaired fasting glucose of 100 to 125 mg/dl, impaired glucose tolerance of 140 to 199 mg/dl, or both.)

According to an American College of Endocrinology (ACE) task force, about 6 to 10 percent of patients with impaired glucose tolerance develop diabetes each year, while 60 percent of patients who have both impaired fasting glucose and glucose tolerance develop diabetes within six years. 

In response to these statistics, healthcare providers are starting to reach a consensus:  Treating pre-diabetes should be a pull-out-all-the-stops effort that rivals the aggressiveness with which they currently treat newly diagnosed cases of diabetes. 

The five main elements of this assertive approach to pre-diabetes include:


  • Routine administration of the A1c test to patients to detect abnormal levels of glucose or glucose resistance
  • Adoption of the ACE recommendation that doctors prescribe metformin and acarbose to control glucose levels in pre-diabetics before they get out of control
  • Implementation of a further recommendation that pre-diabetics meet the same lipid and blood pressure targets that apply to diabetics who are using statins, ACE (angiotensin-converting enzyme) inhibitors, and angiotensin receptor blockers
  • At least 30 minutes daily (150 minutes per week) of brisk walking, or an aerobic equivalent, for its proven ability to lower blood sugar levels and blood pressure 
  • Weight loss of 5 to 10 percent-even small losses can have a profound effect on blood glucose levels and tolerance 
  • Dietary changes, including a reduction in the consumption of alcohol and carbohydrates, especially carbs high on the glycemic index

The first two elements are a significant departure from current standard treatment. Most doctors have relied in the past on fasting tests for glucose, but have come to realize that many patients do not fast correctly or are subject to blood glucose spikes that a one-time test simply can't reveal. Because the A1c gives a reading over a 90- to 120-day period, it is a far more accurate diagnostic tool.

Many doctors have prescribed metformin to non-diabetic patients to assist with liver function or to address high glucose levels caused by other factors. The addition of acarbose (manufactured by Bayer and called "Precose" in the United States and "Glucobay" in Europe) slows the absorption of sugars and starches into the system and also suppresses appetite. Together, these drugs provide a one-two punch against high BG levels by lowering the amount of glucose the body produces as well as the speed with which it absorbs it.   

The recommendation that people with pre-diabetes meet the same blood pressure and lipid level goals as diabetics means that doctors may soon begin prescribing cholesterol and blood pressure control drugs without waiting for a diagnosis of diabetes.

These more aggressive approaches are intended to delay-perhaps even totally prevent-the onset of diabetes. Given the many harmful and costly side effects that come with diabetes, healthcare professionals are coming to believe that several pounds of prevention are worth a ton of cure.

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Categories: A1c Test, Blood Glucose, Blood Sugar, Diabetes, Diabetes, Diets, Glycemic Index & Carb Counting, Research, Weight Loss

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Posted by seashore on 21 August 2008

It has been reported that up to half of the pancreatic beta cells are typically destroyed in pre-diabetics, and so effective treatment of pre-diabetes is essential. The primary tool that pre-diabetics need is a blood glucose meter, so that they can learn how to control their diets, to stop the progression of their diabetes, and to reverse it. Along with the meter they need clear general guidelines concerning healthy postmeal glucose values. Without a blood glucose meter, a diabetic or pre-diabetic is flying blind.

Health care insurers should be happy to provide blood glucose meters and test strips to pre-diabetics. It is very much more expensive to treat complications from diabetes than it is to halt the diabetes in the early prediabetes state.

Posted by Anonymous on 22 August 2008

A great way to eliminate pre-diabetes is to to what my mother did - cut all carbs (with the exception on vegetables). In 6 weeks her blood profile was perfect and has remained that way ever since. She lost some weight without cutting back on the quantity of food and eats healthier now than ever before. Replacing breads, cereals, pasta, rice & the like with vegetables and fats has restored her health completely!

Posted by bonny on 22 August 2008

Based on my close to 20 years of excellent experience with my t2d, I would think that the best way to prevent pre-diabetes to become full-blown diabetes is through the use of daily exercise of at least a total of 1 hour/day broken down into several sessions. Foods don't have to be restricted based on their glycemic index as long as they are all heart-healthy. What must be avoided by all means are foods with excess animal fats and those with artificial ingredients. Snacks, soft and hard drinks, and processed and canned foods must be restricted.

Since my diagnosis based on a sky-high fasting sugar of 450+ mg/dl, I have never used any pharma drugs, just regular daily physical activities. All my foods have been heart-healthy, mostly carbohydrates - fresh fruits, vegetables, grains, beans nuts, and occasionally lean pork, lean beak, skinless chicken, fish and other seafoods.

And be a DUMBT2D (disciplined, upbeat, motivated, bold type 2 diabetic) like me.

Posted by dorisjdickson on 5 September 2008

I don't believe these improvements are enough. As I've read, by the time a fasting glucose of 100 is attained, patients have already lost 40% of insulin production. That is too late. Damage is done and complication thresholds are starting to be obtained. Why are the diagnosis protocols so high if we know that a thin, healthy, young average blood sugar is 85! Why do the powers that be think that waiting til a fasting of 140 is OK for anyone's body? If an A1C of 4.2-4.6 is normal why is the marker around 6 for diagnosis?

Posted by Gwenn on 5 September 2008

I find it sad and unfortunate that the first medical approach to the pre-diabetes epidemic includes drugs. As a nutritionist, chemist, and Type I diabetic myself, I wholeheartedly agree that it is imperative that we recognize these folks. But a simple and completely effective method to reversing their pre-diabetes state is to address their diet and lifestyle - a change in these alone can be effective without drug intervention. As the article stated, curbing the carbs is essential, as well as increasing the activity level. As Americans we have a far too high carbohydrate intake, greater than our bodies were made to handle, and we are far too sedentary. Also unfortunate is that too many are not willing to give up the chips, cookies, breads, crackers and sweets. It is far too easy to take a pill than to discipline oneself. The diabetes drugs only address the symptoms, they do not address what is causing the high blood sugars. The blame is on the physicians, who would rather lead a patient down a path of managed disease than to lead them to a disease-free life through healthy choices.But they just don't know. Health through nutrition is possible and is rarely sought by mainstream medicine - we are what we eat.

Posted by Anonymous on 5 September 2008

I want to need the total cure of Diabetes and Blood pressure

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