Three White Coats
Prediabetes
Prediabetes is a condition characterized by higher-than-normal levels of glucose in blood. Although the name and the absence of obvious symptoms can be misleading (aren’t we always in a "pre-disease" state until we are actually diagnosed?), prediabetes should, indeed, be taken seriously as it indicates a high likelihood of type 2 diabetes developing within 10 years. At the same time, it is important to know that progression to diabetes is not inevitable: diabetes can be prevented! Diagnosis of prediabetes should, therefore, be looked at as an excellent opportunity to intervene and change the course of your health.
Risk Factors
Most often patients do not experience any symptoms. For this reason, it is important to recognize those factors that make a person more likely to be diagnosed with prediabetes:
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A family history of diabetes (mother, father, sister, brother)
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Body Mass Index (BMI) higher than 25
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Waist circumference larger than 35 inches for women and 40 inches for men
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Sedentary lifestyle
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High blood pressure
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Age over 45
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Ethnic Background (African American, Asian American, Hispanic, American Indian and Pacific Islander)
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Diabetes during pregnancy (gestational diabetes)
If you have one or more of the aforementioned risk factors, visit your doctor and have your blood glucose levels checked. Your chances of successfully preventing diabetes (or delaying its onset) are higher when you are aware of the problem early on and can make a timely intervention.
Diagnosis
Prediabetes is diagnosed by determining glucose levels in blood. Blood glucose can be determined by performing several blood tests:
Fasting glucose test
This test is done in the morning, after 8-10 hours of overnight fasting. Do not change your eating habits before the test, as you want the test to reflect your “usual” fasting glucose levels. If the results show higher than normal levels of fasting glucose, it is important to re-do the test in a couple of days (again, without introducing any changes in diet or physical activity).
Glucose tolerance test
This test is done only if the fasting glucose test shows higher than normal values (but not if the levels indicate overt diabetes). It is done in the morning, after 8-10 hours of overnight fasting. No dietary or changes in physical activity should be made at least 3 days before the test. For this test, glucose levels are determined prior to and two hours after the consumption of a special glucose solution.
Hemoglobin A1C test
This test does not require fasting and can be performed at any time of the day. Results represent average glucose levels two to three months prior to taking the test.
Treatment
Pharmacologic therapy
Among various drugs that can help prevent diabetes, only metformin (Glucophage), has the efficacy and the safety profile that make it suitable to be recommended to high risk patients (women with gestational diabetes, patients younger than 60 and patients with a BMI > 35). It is important to note that lifestyle changes (healthy diet and exercise) are more effective preventive tools than any drug, including metformin.
Lifestyle changes
Weight loss
Weight loss achieved through healthy eating and regular physical activity is clinically proven to be effective in preventing diabetes. A large clinical trial (3243 participants from 27 clinical centers throughout the U.S.) found that about 2 pound (one kilogram) weight loss reduces diabetes risk by 16 %.
Smoking
Several studies have shown the correlation between smoking and increase in diabetes risk. It is essential that efforts to quit smoking be accompanied by a healthy diet and exercise. This will prevent weight gain (common in those who quit smoking) associated with a higher risk of diabetes.
Lifestyle Medicine
Healthy Diet for Weight Loss
Proper eating habits are not only important for prevention of diabetes, but for achieving and maintaining optimal overall health. While it is important to focus on weight loss (remember, there is a direct correlation between weight loss and diabetes risk) you must not neglect proper nutrition. There are too many diets that promise dramatic and quick weight loss but also result in a dangerous exclusion of essential nutrients. Your goal has to be a healthy weight loss.
Be Physically Active
A large body of data shows that active people have a significantly lower risk for a host of conditions: type 2 diabetes, heart disease, stroke, some cancers (breast and colon), osteoarthritis, depression, dementia. What is especially interesting and appealing about the physical activity as a preventive tool, is its efficacy - very little goes a long way! One study showed that only 15 minutes a day increased life expectancy by 3 years!
Glycemic Index and Glycemic Load
Carbohydrates should be an essential part of your diet. They feed our cells and are the only source of energy for the brain and the red blood cells. Besides making sure that you stay within the recommended values for carbohydrate intake (45-65% of daily calories), you also need to pay attention to the quality of the carbohydrates that you consume. Glycemic index and load are food ranking systems designed to help people with diabetes chose the “good” carbohydrates.
Boosters
Fenugreek
Fenugreek (Trigonella foenum-graecum), an aromatic annual plant with clusters of small yellow flowers, has been appreciated as a medicinal herb since ancient Egyptian times. The medicinal part of the plant, its dried seeds, are the staple spice in Indian, Middle Eastern and Ethiopian cuisines. Of all medicinal properties ascribed to fenugreek, it is its ability to lower the levels of blood glucose and lipids that has received the most scientific attention.
Alpha-lipoic acid
Dubbed a “universal antioxidant” for its solubility in both fat and water and its wide range of action, alpha-lipoic acid also acts as a cofactor (enzyme helper) for various enzymes involved in energy production, and carbohydrate and protein metabolism. In food, it is found in small amounts in kidney, heart, spinach, broccoli and potatoes. Alpha-lipoic acid has been used for many years to help control neuropathy associated with diabetes.
Cinnamon
A popular spice, cinnamon has been widely used since ancient times. Clinical trials that investigated the use of cinnamon for glycemic control have been rather small in size and provided conflicting results. The most recent review study suggested cinnamon's efficacy in lowering blood glucose and triglyceride levels in patients with type 2 diabetes. However, very little is known about the optimal dose or duration of the cinnamon therapy.
Fiber for glycemic control
Unlike other carbohydrates, the ones that constitute dietary fiber are not digested in our bodies and thus do not increase blood glucose levels. However, consumption of fiber alongside digestible carbohydrates modifies the way they are processed in the body. The results from 35 clinical studies indicate that fiber supplementation improves glycemic control both in diabetic and prediabetic patients. In addition, an increase in fiber intake may also help with weight loss.
Last updated: August 15, 2016