Jul 25, 2008

Knocking Out Prediabetes

Tara Dairman

If you are one of the more than 56 million Americans who have prediabetes, more guidance on how reduce your risk of Type 2 diabetes may be on the way. This week, the American Association of Clinical Endocrinologists (AACE) agreed to recommend an aggressive approach to treating prediabetes, releasing the first official treatment recommendations that have been made for this condition.

What Is Prediabetes?
People who have a fasting blood glucose level of 100 to 125 mg/dl are considered to have prediabetes. (A fasting blood glucose level over 125 mg/dl indicates full-blown diabetes.) People who have prediabetes are at increased risk for cardiovascular disease, and most go on to develop Type 2 diabetes with in 10 years.

The AACE now recommends a "two-pronged approach" for preventing the conversion of prediabetes to diabetes and lowering cardiovascular risk.

Step 1: Diet, Exercise…and Drugs?
First, the AACE recommends intensive lifestyle change, following the guidelines set forth in the Diabetes Prevention Program (DPP).

The DPP, a study published in 2002 that involved more than 3,000 people with prediabetes, showed that losing 5% to 7% of their body weight lowered people's risk of Type 2 diabetes by 58% over three years. The participants lost weight by dieting (cutting fat and calories) and exercising moderately (walking was the most popular exercise) for at least 150 minutes a week (about 20 minutes a day). You can read more details about the DPP at http://diabetes.niddk.nih.gov/dm/pubs/preventionprogram.

The AACE experts also agreed that certain drugs may play a role in treating prediabetes if diet and exercise do not lower people's blood glucose levels enough. In the DPP, the diabetes drug metformin (Glucophage and other brand names) was shown to help prevent Type 2 diabetes in people with prediabetes, though not as effectively as diet and exercise. A more recent study of 602 people, presented at the American Diabetes Association Scientific Sessions in June, found that people with prediabetes who took pioglitazone (Actos) were 81% less likely to develop full-blown diabetes over three years compared to people who took a placebo drug. However, the pioglitazone group did gain more weight than the placebo group (about 8 pounds vs. 2 pounds). The study was sponsored by pioglitazone manufacturer Takeda. As of now, no drugs are officially approved for the treatment of prediabetes.

Step 2: Reduce Cardiovascular Risk
The AACE's second recommendation focuses on lowering the risk of cardiovascular disease (for example, heart attacks and stroke) that faces people with prediabetes. It recommends that these people be screened and treated for high blood pressure and high cholesterol, and that drugs be used if diet and exercise do not improve these risk factors enough.

What Else Can You Do?
Many people who have prediabetes have not been diagnosed with the condition and remain at high risk of developing Type 2 diabetes. Factors that raise a person's risk of prediabetes and Type 2 diabetes include having the metabolic syndrome (a cluster of interrelated conditions, also known as syndrome X), having had gestational diabetes (diabetes during pregnancy), having a history of Type 2 diabetes in the family, and belonging to certain racial and ethnic groups (African-American, Native American, Asian American/Pacific Islander, and Hispanic American/Latino).

If you have prediabetes, talk to your health-care provider about aggressively taking steps to prevent Type 2 diabetes. And if you think you may have prediabetes, get tested and encourage other people who may be at risk to do the same.

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