Saturday, June 23, 2018
Health

Prediabetes can be the wake-up call that prevents Type 2 diabetes, but patients need to act

Dianne Muncey's doctor first talked with her about prediabetes in 2013.

With a family history of Type 2 diabetes and blood glucose levels that had been creeping up for years, the doctor explained that Muncey was at high risk for diabetes herself. She was told to lose some weight, exercise and change her diet, but was given no specific instructions on exactly how to do that.

She was on her own.

"And, I just didn't do it," said Muncey, a retired teacher's assistant from Tampa, whose parents and four siblings had Type 2 diabetes. "They didn't give me any guide or a plan to follow, just general recommendations."

A year later, Muncey decided it was time to focus on her health and deal with the diabetes threat. She found a diabetes prevention class at the YMCA that her health insurance plan would pay for, but first she had to submit some blood test results.

That's when she got the bad news. Prevention was no longer an option. The now-69-year-old had "transitioned," as doctors often say, from prediabetes to Type 2 diabetes, a diagnosis that will follow her for life, even if the condition is well-controlled.

In prediabetes, blood glucose levels are higher than normal, but not quite high enough for a diagnosis of Type 2 diabetes. Up to 30 percent of those with prediabetes will go on to develop Type 2 diabetes, putting them at risk for lots of serious health problems, including heart attack, stroke, high blood pressure, kidney disease, limb amputation, blindness, digestive problems and nerve damage, particularly in the hands and feet.

The good news is Type 2 diabetes often can be prevented if people at high risk are identified early, their blood glucose levels are closely monitored and they follow medical advice to change their diet, exercise and lose weight.

"We know we can prevent it with very modest changes in their lifestyle, such as losing as little as 10 pounds," said David Marrero, a researcher and professor of medicine at Indiana University School of Medicine and immediate past president of health care and education for the American Diabetes Association. "Type 2 diabetes is extremely preventable, but we first need to make people aware that prediabetes is a real problem and that they need to take action if they have it."

Marrero was part of a team of experts who worked with the American Diabetes Association, the Centers for Disease Control and Prevention, the American Medical Association and the Ad Council to produce the first national public service campaign aimed at increasing awareness of prediabetes.

"Eighty-six million adults have prediabetes, 90 percent don't know it because it usually causes no obvious symptoms," Marrero said. "So you can be walking around with it, a serious metabolic disorder, which increases your risk for Type 2 diabetes, and not know it."

The campaign, a series of humorous videos, radio spots, and a one-minute online risk assessment quiz, urges Americans to find out where they stand when it comes to diabetes risk factors and blood glucose levels. Those with prediabetes are told to turn that knowledge into action by losing weight, exercising, changing diet and managing stress.

The campaign aims to get the attention of people at risk for diabetes, but it appears physicians may need to pay attention, too. New research finds that few in primary practice have the conversation that Muncey's doctor had with her about prediabetes.

A new study from the University of Florida reviewed data from the 2012 National Ambulatory Medical Care Survey representing thousands of office visits made by hundreds of patients. The patients were seen by family or internal medicine physicians all across the country.

Thirty-four percent of the patients met the criteria for prediabetes. But, of that group, only a few were told they had the condition, and just 23 percent received instructions or medication for managing it.

"That's a missed opportunity for prevention of Type 2 diabetes," said Arch Mainous, lead author on the study and professor and chair of the Department of Health Services Research, Management & Policy at the University of Florida College of Public Health and Health Professions. "These doctors had current lab values on these patients right in front of them and they didn't diagnose them and didn't offer any treatment either."

Mainous is conducting another study, surveying thousands of family doctors to find out why this is happening.

"If we identify people with prediabetes and tell them they are most likely to transition to full diabetes and then intervene with medication or a specific plan of lifestyle changes," he said, "it will slow or prevent Type 2 diabetes and that's the key — prevention."

The study appears in the March 8 Journal of the American Board of Family Medicine.

Doctors who specialize in weight management are in a unique position to check for and discuss prediabetes with patients. Dr. Denise Edwards is an assistant professor of internal medicine and pediatrics at USF Health and director of the Healthy Weight Clinic.

"I see a lot of prediabetes in my practices, in adults and children," she said, "But I'm always looking for it because obesity, being overweight, is a major risk factor for diabetes."

Edwards sees at least four new cases of prediabetes each week and is used to counseling patients on what it is and what they should do about it to prevent full diabetes. Making the necessary changes isn't always easy. She has two psychologists who work with patients who are struggling.

"We're talking about making a lot of behavior changes and that can be very difficult," she said.

Having a name for the condition helps, too. It motivates people to take prediabetes seriously and to stick with exercise goals and changes in diet.

"Having that label, that name, makes it a medical issue. It's a diagnosis," said Edwards. "When they hear their doctor say that, it may be the first time they learn that their weight is tied to serious medical problems. It's not just a cosmetic issue."

Dianne Muncey went ahead and took that diabetes prevention class at the Y and learned a lot. She had never kept a food diary before and was surprised to see how much fat was in her diet. Since taking the class she has gotten her blood glucose down to a healthy number and lost 26 pounds.

She fills her days with exercise, including Zumba, yoga and water aerobics. It's keeping her busy in retirement, and healthy.

Contact Irene Maher at [email protected]

     
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