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Pre-diabetes: Ignore It at Your Own Peril

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THURSDAY, Nov. 11 (HealthDayNews) -- Doctors call it pre-diabetes, the period when people at high risk of full-blown diabetes exhibit elevated blood-sugar levels. But they're still capable of processing that sugar, called glucose -- the energy that fuels the body's cells.

But if those people don't take the necessary steps to bring their blood sugar levels under control, they could eventually succumb to such devastating diabetes-induced complications as heart disease, blindness, kidney failure and amputations.

Some 41 million Americans are estimated to have pre-diabetes, according to recently revised government guidelines. And because November is American Diabetes Month, doctors are taking the opportunity to warn people that even if they don't have diabetes, their bodies still may be suffering damage from elevated blood sugar.

"If we can identify people before they get to the point of having diabetes, we can intervene," said Cathy Tibbetts, president of health care and education for the American Diabetes Association. "In about 58 percent of the cases, with healthier eating and increased physical activity and a moderate loss of weight, people can successfully avoid diabetes or delay its onset."

About 18 million Americans have diabetes, with 1.3 million new cases diagnosed annually. The disease kills more than 200,000 Americans every year, making it the sixth leading cause of death in the United States, according to federal statistics.

While an estimated 13 million people have been diagnosed with diabetes, 5.2 million people are unaware they have the disease, the American Diabetes Association reports.

Diabetes is a disease in which the body does not produce or properly use insulin, a hormone that's needed to convert sugar, starches and other food into energy for cells. Most people have type 2 diabetes, which develops as the body gradually loses its ability to metabolize blood sugar.

The U.S. government adopted new guidelines this year for determining whether a person is at risk for diabetes. Under those guidelines, two of every five adults aged 40 to 70 is now considered to have pre-diabetes.

Under previous guidelines, a person was considered to have pre-diabetes if their sugar level after an all-night fast was 110 milligrams per deciliter of blood. Now, pre-diabetes is diagnosed for sugar levels between 100 and 125 mg/dl.

The change makes sense given that those elevated levels are doing harm to the body even though the person isn't suffering from diabetes, said Dr. Robert Rizza, a professor of medicine at the Mayo Clinic's Division of Endocrinology, Metabolism, Diabetes and Nutrition.

"If you look at people whose blood sugars are at that level, you can already find evidence of the damage caused by diabetes," Rizza said.

For example, people with pre-diabetes have a 50 percent greater risk of heart attack and stroke, Tibbetts said. Once they actually have diabetes, their risk of heart disease increases to two to four times that of someone without diabetes.

People whose post-fast blood sugar falls between 100 and 110 have a 20 percent higher chance of developing diabetes than those whose blood sugar is healthier. Those with blood sugar between 110 and 125 are at 40 percent greater risk. Levels of 126 or above are considered diabetes.

The American Diabetes Association believes the rampant spread of diabetes and its precursors are caused by factors that can be managed by the individual.

"We've gotten into some bad habits as a society," Tibbetts said. "We're less physically active and eating larger and larger amounts of food."

Since 1990, obesity has increased by more than 60 percent in the United States. And type 2 diabetes, which is closely linked to obesity, has soared by nearly 50 percent, according to the diabetes association.

People with pre-diabetes can avoid or delay the onset of full-blown disease by eating sensibly and becoming more active, Rizza said.

"The most important thing is to stay lean and become fit," he said. "If you're overweight, lose weight. And if you're sedentary then increase your activity. It's as simple as that."

Losing just 5 percent of body weight -- 10 pounds for a 200-pound adult -- can bring a person's blood sugar down below pre-diabetes levels.

The diabetes association recommends that people exercise portion control. Simply eating less can go a long way toward arresting obesity.

Other association diet tips include:

  • Eat a total of five servings of fruits and vegetables every day.
  • Aim for at least six daily servings of unrefined starches such as bread, cereals and starchy vegetables.
  • Eat sugar, sweets and desserts in moderation. These foods tend to be high in calories and fat and contain few vitamins and minerals.

Physical activity also is an important part of weight management, and thus an important way to avoid diabetes. Exercise can boost your metabolism, increase muscle mass so you burn more calories, and help improve the body's response to insulin and naturally help to lower glucose by burning extra calories.

More information

To learn more, visit the American Diabetes Association.

rofessor, medicine, Mayo Clinic's Division of Endocrinology, Metabolism, Diabetes and Nutrition, Rochester, Minn.; Cathy Tibbetts, R.N., MPH, CDE, president, health care and education, American Diabetes Association
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