As a westernized country we can be proud of our climb to higher levels in many achievements, but not when it comes to type II diabetes. The rate of this disease continues to climb and devastate our health. According to the Centers for Disease Control and Prevention (CDC), 25.8 million persons in the US (8.3% of the population) have type II diabetes. Two million of us will get this diagnosis next year. Diabetes is often stealthy and silent as it causes irreversible complications. Full blown diabetes is usually preceded by a lengthy period in which there are no overt symptoms, (prediabetes). During the “pre” stage, there is a mild elevation of blood glucose levels and insulin resistance. (The insulin is less effective, hence more needs to be secreted whenever there is a sugar load.) With time, the pancreas begins to have difficulty in fulfilling its glucose balancing role and ceases to appropriately secrete insulin; finally it fails and diabetes II develops. Currently, 79 million Americans are estimated to have prediabetes.
Diagnosis, interventions and early therapy can make a huge difference when it comes to both prevention of type II diabetes and the future health of anyone who is at risk. Hence, I was delighted to see a review article in the August issue of New England Journal of Medicine which detailed the most recent recommendations for diagnosis of prediabetes and diabetes…And as you probably know, blood tests are paramount. A patient is diabetic if her fasting blood glucose is 120 mg/dL or more, or if her glycated hemoglobin level (Hemoglobin A1c) is 6.5% or more. Glycated hemoglobin measures the level of glycation or attachment of sugar to the most prevalent protein in blood and correlates well with the average blood glucose levels during the previous 2 to 3 months. In other words it “tells” on your blood sugars during the 2 to 3 months prior to the blood test and is a wonderful indication of how you have been doing glucose-wise.
You are considered prediabetic if you have a fasting glucose level of 100 to 125 mg per deciliter or have a hemoglobin A1c of 5.72 to 6.4%.
So when you should be tested? The American Diabetes Association (ADA) recommends that everyone should begin diabetic screenings at 45 years of age and that if normal, the testing be repeated every 3 years. But they also advise screening earlier for individuals who have risk factors. They state that screening should be done at any age and more frequently if the person’s body mass index is 25 or more and that person has at least one additional risk factor…And there are a lot of risk factors:
- Family history of diabetes (in a first degree relative)
- High risk race (Black, Native American, Asian, and Pacific Islander) or ethnic group (Hispanic)
- History of hemoglobin A1c level of 5.7% or more, impaired fasting blood sugar or impaired glucose tolerance on previous testing (including that done for gestational diabetes)
- Polycystic ovary syndrome
- HDL cholesterol level of less than 35 mg%, triglyceride level of more than 250 mg % or both
- History of cardiovascular disease
- Physical inactivity…Please note!
- Severe obesity
Just so you know how important blood glucose levels and glucose tolerance results are, the authors note that individuals with “impaired” i.e. abnormal, fasting glucose together with an abnormal glucose tolerance have a 10 to 15% chance of developing diabetes per year. Moreover, prediabetic states are associated with increased total mortality.
The article goes on to delineate the advantages and disadvantages of available screening tests:
- Fasting glucose is widely available but requires (obviously) fasting and can be influencedby acute illness or instability in the test tube.
- An oral glucose tolerance test which requires fasting followed by ingesting a known amount of glucose and subsequent blood tests over the next few hours. This requires time; inconvenience, costs more and results can vary.
- Glycated hemoglobin does not require fasting and is stable even during acute illness. It is closely correlated with disease and its complications.
Knowing whether you are prediabetic can have a major impact on your future health. Studies have shown that risk reduction with aerobic exercise for at least 30 minutes on most days of the week and a calorie restricted diet enabling you to lose 7% of your body weight can decrease your risk of developing full blown diabetes over the next 3 years by 58%! If despite this you don’t achieve the “right” blood sugar levels a medication that improves the way your body recognizes and responds to sugars (metformin) may help prevent full blood disease.
Bottom line: Make sure you are tested for prediabetes and diabetes once you turn 45 and if the test is normal; have it repeated every 3 years. Start sooner if you are at risk; many of us are! Your sugar levels today can have a major impact on your health tomorrow.