Exercise and Nutrition Counseling for Prediabetes

As David Spero noted in a blog post a few weeks ago here at DiabetesSelfManagement.com, the U.S. Preventive Services Task Force (USPSTF) has released new guidelines — updated for the first time since 2008 — regarding blood glucose screening in people who have no symptoms of diabetes or prediabetes. As a recent NPR Shots article on the recommendations notes, the USPSTF is an official body whose recommendations carry special weight under the Affordable Care Act (“Obamacare”). This means that most private and public health insurance plans are required to offer preventive services recommended by the group for free — without any copays or deductibles applied.

The new guidelines recommend that anyone between the ages of 40 and 70 who is overweight or obese (defined by a person’s body-mass index, or BMI) be screened for diabetes or prediabetes (in which blood glucose is elevated, but not to diabetes levels). It also recommends referring people with either condition to nutrition and exercise counseling, which can be offered by a health-care provider or take place somewhere else in the community. Since an estimated 86 million Americans had prediabetes in 2012, this means there could be a huge increase in demand for lifestyle intervention programs that would be completely covered by insurance plans.

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The USPSTF recommendations state that there is “adequate evidence that intensive behavioral counseling” for people at higher risk for cardiovascular disease — which includes people who are overweight and have prediabetes — has “moderate benefits in lowering” their cardiovascular risk. Furthermore, studies have shown that lifestyle intervention programs for prediabetes “show a moderate benefit in reducing progression to diabetes.”

It’s far from certain, though, that lifestyle intervention programs have any measurable effect on health outcomes like eventual complications of diabetes, or risk of dying. Furthermore, it can’t be known that the established benefits of lifestyle interventions for people with prediabetes — a lower risk of cardiovascular disease, and a reduction in progression to diabetes — will apply to the much larger group that will be screened for prediabetes and diabetes under the new guidelines. The 2008 guidelines recommended screening only in overweight or obese people who also had high blood pressure, who probably have a higher cardiovascular risk — and possibly a higher diabetes risk — to begin with than the new, expanded group that’s covered by the guidelines.

What’s your take on these recommendations — is it good that insurance companies have to cover blood glucose screening for more people, free of charge? Should the guidelines have gone further, offering younger people — or those who aren’t overweight or obese — free screening? If you have Type 2 diabetes, were you previously diagnosed with prediabetes? If so, do you think it was helpful to know you had prediabetes? Did you take part in any diet or exercise counseling programs, and if so, do you think they helped you improve your health? Leave a comment below!

  • Margaret Vernier

    I support diagnosing and treating prediabetes because of my own positive experience: Seven year ago, I was diagnosed as glucose intolerant/prediabetic because a glucose tolerance test yielded a reading a little over 200, even though my weight was normal, and fasting blood glucose and a1C were at top of the normal range. Even though type 2 diabetes runs in my family, I was stunned at the diagnosis, and started working with an endocrinologist and nutritionist. After seven years, my fasting blood glucose, a1C and weight are still normal, and I credit this to nutritional counseling, after-meal glucose testing (which was frequent at first but less often now), and periodic labwork. Without this support system, I would not likely maintain my vigilant habits.

  • EdwardsTom

    Having recently been diagnosed with prediabetes, I have substantially changed my eating habits and have increased the amount that I exercise. I strongly support testing people early and often. If led a relatively healthy lifestyle before, but, if I had known sooner I would have eaten fewer carbs and exercised more.