The Prediabetes Epidemic

Without intensive early intervention, up to 30 percent of those with prediabetes will progress to type 2 diabetes within five years of their diagnosis.

Diabetes is an all too common chronic disease. In 2012, 12.4 percent of the population over the age of 20 had diabetes.  Incidence of the disease rises with age: by 2014, 21.5 percent of Americans aged 65-74 and 19.2 percent aged 75+ had diabetes. It continues to be a leading cause of cardiovascular disease, lower extremity amputations that are not due to injuries, end-stage renal disease and blindness.

Diabetes is diagnosed based on test results revealing a blood glucose level of 126 mg.dl, a hemoglobin A1C of 6.5% or more (A1C is a measure of a patient’s mean blood glucose level over the preceding three prediabetesmonths), and a failing glucose tolerance test (one that shows a 2 hour, post-meal blood glucose level > 200 mg.dl Up to half of the people with diabetes are not aware that they have it and many are diagnosed only when a complication develops.

Decisive clinical trials have shown that better treatment of diabetes—including controlling blood glucose, cholesterol and blood pressure—will decrease the risk of complications of the disease. This is heartening, of course, but it would be even more heartening if people at risk of the disease could mobilize to prevent it.

Prediabetes is a condition that may progress to diabetes. Fifteen to 30 percent of people with prediabetes will develop type 2 diabetes within five years of a prediabetes diagnosis, unless they participate in intensive, early intervention. There is a 50-70 percent risk of people with prediabetes developing diabetes in the course of their lifetime.

In 2012, studies found the incidence of prediabetes in adults over the age of 20 to be 36 percent, with 51 percent of Americans aged 65+ having the condition. A person has prediabetes when his or her blood glucose is abnormally high, yet still lower than the levels seen in a person with diabetes. The condition is diagnosed when a patient’s fasting blood glucose tests 100 mg./dl-125 mg./dl; when hemoglobin A1C tests 5.7% mg./dl-6.4% mg./dl; and when a 2-hour post-meal blood glucose level tests 140 mg./dl-199 mg./dl.

HALTING THE PROGRESSION

The good news for the 86 million Americans who currently have prediabetes is that weight loss and exercise together can have a dramatic impact on delaying or preventing the progression of prediabetes to diabetes. The results of a clinical trial conducted by the Diabetes Prevention Program (DPP), published in 2002, found that weight loss of seven percent of body mass combined with exercise of 150 minutes per week (similar in intensity to brisk walking) reduced the risk of progressing to diabetes by 58 percent for the entire study population. For those over the age of 60, the risk for diabetes was reduced by 71 percent.

As a result of such research findings, many insurance companies now pay for nutrition education as well as for glucose testing supplies when an insured person has a diagnosis of prediabetes. In March of this year, the Centers for Medicare & Medicaid Services announced that Medicare will soon add coverage for participation in the National Diabetes Prevention Program (National DPP), a network of community-based, lifestyle intervention programs administered by hospitals, health care centers and community organizations. Delivered in a classroom setting by trained coaches, the National DPP provides a supportive, small group environment to promote healthier eating habits and increase physical activity. It consists of an intensive, 12-month, evidence-based intervention that includes 16 weekly core sessions followed by monthly maintenance sessions.

Visit the National DPP website at www.cdc.gov/diabetes/ prevention to learn more or to locate a nearby program. You can even sign up for the Online Program, which follows a CDC-approved curriculum and includes a lifestyle coach, either in a group format or one-on-one.