Delaying the Progression from Pre-diabetes to Type 2 Diabetes: What Patients Should Know

Type 2 diabetes, also known as diabetes mellitus, is a major public health problem in the United States. According to statistics from the Centers for Disease Control (CDC), an approximate 8% of the U.S. population is currently afflicted. Additionally, 57 million Americans are thought to be pre-diabetic, which equates to nearly 19% of the U.S. population (1).

Pre-diabetes is defined by the American Diabetes Association as having a fasting plasma glucose level between 100 and 125 mg/dL, or plasma glucose level of 140 - 199 mg/dL after an oral glucose tolerance test (2). The current estimate of the number of Americans with pre-diabetes is alarming considering a study, published in the journal JAMA 2001, demonstrated that the incidence of diabetes development in individuals with pre-diabetes is 64.5%, compared to only 4.5% in those with normal plasma glucose levels (3).

The next question that should be raised by pre-diabetic patients reading this article is: what benefit is there for preventing the development of diabetes from a pre-diabetic state? There is no easy answer for this question, as a substantial amount of solid outcome data is lacking between the two pathologies. However, the risk of life threatening complications in diabetic patients is well known and extensively documented (2). Furthermore, a recent study published in the journal Diabetes Care concluded that the worsening of glycemic control in pre-diabetic patients leads to an increase in risk factors associated with cardiovascular events (4). The same study also suggested that improving glycemic control, whether pharmacological or lifestyle, in pre-diabetics reduced the same cardiovascular risk factors that were increased when plasma glucose control was worsened.

So what steps can a pre-diabetic take to prevent the transition to type 2 diabetes? According to numerous clinical trials, both a pharmacological approach and lifestyle changes are effective. Although, lifestyle modification should be the very first consideration raised by clinicians. Trials where patients with glucose intolerance decreased fat and sugar intake, along with reducing weight by exercise, decreased the probability of developing diabetes (5, 6, 7). The use of pharmacological agents such as metformin, that increase sensitivity to endogenous insulin and decrease glucose production by the body, also decrease the chance of progressing to type 2 diabetes (7).

Current diabetes treatment guidelines suggest that patients with pre-diabetes receive medical nutritional management for a specifically tailored diet (2). The guidelines also recommend losing 7% body weight and performing approximately 150 minutes of physical activity every week. Although patients with pre-diabetes should consult a nutritionist, the guidelines recommend several basic dieting principles. These include meeting the USDA recommendations for fiber intake, reducing both saturated fat and alcohol consumption, and careful carbohydrate intake. However, a nutritionist should be seen by pre-diabetic patients to tailor their diet for their specific likes and dislikes, along with clearing up any questions on how and what to eat for an optimized diet.

If you are a pre-diabetic, reducing the transition to full blown diabetes is generally thought to reduce morbidity and mortality (8). Speak to your doctor about being referred to a nutritionist to optimize your diet and lifestyle in obtaining clinically demonstrated diabetes prevention. Diabetes is not only astronomically expensive to treat, it can lead to debilitating consequences for ones overall health and well being.

References:

1. Number of People with Diabetes Increases to 24 Million. http://www.cdc.gov/media/pressrel/2008/r080624.htm. accessed 2/25/10.
2. Standards of medical care in diabetes--2010. Diabetes Care. 33 Suppl 1: p. S11-61.
3. de Vegt, F., et al., Relation of impaired fasting and postload glucose with incident type 2 diabetes in a Dutch population: The Hoorn Study. JAMA, 2001. 285(16): p. 2109-13.
4. Goldberg, R.B., et al., Effect of progression from impaired glucose tolerance to diabetes on cardiovascular risk factors and its amelioration by lifestyle and metformin intervention: the Diabetes Prevention Program randomized trial by the Diabetes Prevention Program Research Group. Diabetes Care, 2009. 32(4): p. 726-32.
5. Lindstrom, J., et al., Prevention of diabetes mellitus in subjects with impaired glucose tolerance in the Finnish Diabetes Prevention Study: results from a randomized clinical trial. J Am Soc Nephrol, 2003. 14(7 Suppl 2): p. S108-13
6. Tuomilehto, J., et al., Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med, 2001. 344(18): p. 1343-50.
7. Knowler, W.C., et al., Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med, 2002. 346(6): p. 393-403.
8. Nathan, D.M., et al., Impaired fasting glucose and impaired glucose tolerance: implications for care. Diabetes Care, 2007. 30(3): p. 753-9.