One in three American adults has prediabetes, and to make matters worse, only a small fraction of these people know it!
I consider this to be a national emergency. If we fail to detect and reverse prediabetes, then how are we going to stand any chance at reducing the growing epidemic of type 2 diabetes?
I caution nondiabetics who are overweight and over age 50 to assume they have prediabetes until proven otherwise. Prediabetes involves mildly increased blood sugar levels, most commonly after meals but sometimes also in the fasting state. This occurs because the pancreas organ can no longer produce enough insulin hormone to sustain normal blood sugar levels (usually about 50% loss of function in prediabetes). Doctors usually diagnose prediabetes with a simple fasting blood sugar level (at least 110 mg/dL) or a hemoglobin A1c level (at least 5.7%). Adults who are overweight or over age 45 should typically be screened for prediabetes/diabetes.
Individuals with prediabetes typically go on to develop type 2 diabetes, especially if they do not take steps to delay or prevent this disease via lifestyle changes. Primary care providers have a great opportunity to uncover the huge number of prediabetics out there. I’ll estimate that 40%-50% of a typical primary care panel has prediabetes or type 2 diabetes, but that the minority of these patients are diagnosed. It is crucially important to find and warn these patients because lifestyle change, especially weight loss, can really make a tremendous difference in delaying or preventing progression to type 2 diabetes.
We know from clinical trials (Diabetes Prevention Program, Finnish Diabetes Prevention Trial) that long-term weight loss in the 4% range delays the progression of from prediabetes to type 2 diabetes by about 4 years longer than when no weight loss occurs. The greater the weight loss the longer one can expect to delay diabetes. In fact, my working assumption is that prediabetics who achieve long-term weight losses of 10% will delay diabetes by about 10 years, and those who maintain weight losses of 20% will delay diabetes by about 20 years, and so on. I can’t prove it, but I think this is a reasonable guess. The crucial point is that the rate of progression from prediabetes to type 2 diabetes is exquisitely sensitive to weight loss, and failure to recognize and capitalize on this fact amounts to a shamefully wasted opportunity in my view.
Now, we all recognize that sustaining weight losses on a long-term basis, even in the 4% range, is no easy feat. However, patients stand a much better chance if they participate in a formal program designed for long-term results. We now have much greater experience in designing programs that can cost-effectively achieve this degree of weight loss.
If we in the medical profession make it a priority, we can offer good weight loss support and a better chance at living a fuller life, to the enormous number of undiagnosed prediabetics out there who would like the chance to be found and helped. The medical profession has a pivotal role in addressing this national emergency. I challenge current and future leaders to recognize and act on the alarm I and others are sounding now, in the early stages of catastrophe.
- Michael Dansinger, MD