When I'm seeing a recent patient, I'm especially alert to certain pieces of their history. Do they’ve a robust family history of diabetes? Are they of Latino, Asian, Native-American, or African-American descent? Did they’ve gestational diabetes? Are they chubby or obese? Do they’ve polycystic ovarian syndrome (PCOS)?
Why do I care about this stuff? because they could indicate that the patient is in danger for adult-onset diabetes (type 2), and That Can result in quite a few major medical problems.
Many people have heard of type 2 diabetes, a disease wherein the body loses its ability to manage sugar levels. Adult-onset diabetes often affects individuals with known risk aspects and might take years to totally develop, unlike juvenile (type 1) diabetes, which may develop randomly and rapidly.
Here's why high blood sugar is an issue.
Untreated or undertreated diabetes means persistently high blood sugar, which may cause dangerous artery blockages, resulting in strokes and heart attacks. High blood sugar also causes nerve damage, with burning pains within the legs that eventually give solution to numbness. This, combined with artery blockages, may end up in damaged and dead tissue, which is why many individuals with diabetes find yourself dying. Small blood vessels to the retina are also affected, which may cause blindness. And don't forget the kidneys, that are especially liable to damage from high blood sugar. Diabetes is a number one reason behind kidney failure requiring dialysis and/or kidney transplantation. But wait! There is more. High blood sugar affects white blood cell function for a healthy immune system, and sugar is a serious source of energy for attacking bacteria and fungi. These aspects put people in danger for every kind of nasty infections.
These facts frighten me. Not simply because I'm the doctor who helps manage these fun problems, but because I'm Latino and diabetes runs in my circle of relatives. I’m also in danger.
So, what can we do? If we all know who’s in danger for diabetes, and it takes years to develop, we should always have the opportunity to stop it, right? Okay advantageous!
Prevent pre-diabetes from becoming diabetes
A recent article in Endocrine Specialists calls prediabetes a world epidemic (which it’s).1 Prediabetes is defined by a fasting blood sugar between 100 and 125, or an abnormal result on an oral glucose tolerance test. What can we do to treat pre-diabetes? The authors reviewed several large, well-conducted studies, and all showed that prediabetes might be targeted and diabetes might be delayed or prevented.
The largest study was conducted here within the United States.2 More than 3,000 people from 27 centers who were chubby or obese and had pre-diabetes were randomly assigned to one in all three groups:
- In addition to plain lifestyle recommendations, the drug metformin (Glucophage);
- A placebo pill as well as to plain lifestyle recommendations;
- An intensive lifestyle change program.
The intensive program included individualized dietary counseling in addition to instruction to walk briskly or do 120 minutes of other exercise per week, with the goal of weight reduction.
The investigators followed the topics for 3 years, and the outcomes were consistent with many other studies: People within the intensive lifestyle modification group (dietary counseling and exercise guidance) were less more likely to develop diabetes during this era. I used to be little or no of the 2. of other groups.3, 4, 5 Want the number? The estimated cumulative incidence of diabetes at three years was 30% for placebo, 22% for metformin, and 14% for lifestyle modification. The incidence of diabetes in the life-style modification group was 39% lower than within the metformin group. In fact, they stopped the study early since it was considered unethical to withhold appropriate treatment within the placebo and metformin-only groups.
The authors of the prediabetes review also checked out a large number of other studies that looked more closely at what varieties of diets are helpful and concluded that “the consensus is that a diet high in whole grains , vegetables, fruits, monounsaturated fats and low in animal fats, trans fats and simple sugars are beneficial for maintaining an ideal body weight and active lifestyle.”
It's really just common sense. And that's why my husband and I severely limit our sugar and carbohydrate intake, get four-plus servings of plant-based foods day by day, and exercise.
A word about medicine
For my patients who for whatever reason cannot change their eating regimen and lifestyle, I prescribe a medicine. For patients who’re diabetic and have multiple risk aspects or other diseases, the drug is basically indicated. There are also individuals who need to add medication to eating regimen and exercise to shed weight and further reduce their risk, and that's advantageous too.
I do know using medication for prediabetes is controversial. Other doctors have warned that the “pre-diabetes” label is simply too much of a stretch and is a giant pharma marketing scam.6 It is true that we have now to learn about what we’re proposing and why. But based on what I've seen in my profession, I definitely don't have the desire to make myself diabetic, and for those who're in danger, trust me, you don't either. So, weigh the professionals and cons of every thing, seek advice from your doctor, and judge for yourself what plan of action you desire to take. after which, Take motion.
Sources
- Edwards CM, Cusi K. Prediabetes: a global epidemic.Endocrinology and Metabolism Clinics of North AmericaDecember 2016.
- Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. New England Journal of Medicine7 February 2002.
- Pan XR, Li GW, Hu YH, et al. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da King IGT and Diabetes Study. Diabetes careApril 1997.
- Tuomilehto J, Lindstrom J, Eriksson JG, et al. Prevention of type 2 diabetes mellitus through lifestyle modification in subjects with impaired glucose tolerance. New England Journal of Medicine, 3 May 2001.
- Lindstrom J, Peltonen M, Eriksson JG, et al. Improved lifestyle and diabetes risk reduction over 13 years: long-term follow-up of the randomized Finnish Diabetes Prevention Study (DPS).. DiabetesFebruary 2013.
- Prediabetes: Can Prevention Come Too Soon? Blog post by Richard Lehmann, Cochrane UK Senior Fellow in General Practice, 11 November 2016.