Many miss prediabetes wake-up call

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Type 2 diabetes doesn’t usually appear all of a sudden. Many people have a long, slow, invisible lead-in to it called prediabetes. During this period, blood sugar levels are higher than normal. However, they’re not high enough to cause symptoms or to be classified as diabetes. It’s still possible at this stage to prevent the slide into full-blown diabetes. Think of prediabetes as a wake-up call.

Unfortunately, few people ever hear the alarm. A new report from the Centers for Disease Control and Prevention shows that among Americans age 20 and older, only 10% of those with prediabetes know they have it. Given that as many as 73 million Americans have prediabetes, that’s a lot of missed opportunities to prevent the ravages of diabetes.

One reason many people don’t know that they may be headed toward diabetes is they’ve never had their blood sugar tested. This simple test isn’t part of routine preventive care. The U.S. Preventive Services Task Force recommends blood sugar “screening” only in individuals with high blood pressure. (Screening means hunting for hidden disease in the absence of any outward signs or symptoms.) That’s important, because recommendations from the Task Force, an independent panel of experts, are used by many health-care organizations to determine preventive care. In addition, Task Force recommendations will help determine what services are covered under the Affordable Care Act.

Expanding the net

The American Diabetes Association and other organizations recommend routine blood sugar testing in people at high risk for developing diabetes. These include:

• everyone over age 45
• younger people who are overweight and who also have one of these diabetes risk factors:
  • little or no physical activity
  • family history of diabetes
  • high blood pressure or high cholesterol
  • previous diagnosis of heart disease or polycystic ovary syndrome
  • diabetes during pregnancy (gestational diabetes) or having delivered a baby weighing more than nine pounds

Some experts are encouraging the U.S. Preventive Services Task Force to expand its recommendation on blood sugar screening.

Why bother?

Not everyone with prediabetes will go on to develop diabetes. Over the short term (three to five years), about 25% of people with prediabetes develop full-blown diabetes. The percentage is significantly larger over the long term.

Getting the wake-up call of prediabetes can be very useful. A three-part strategy can keep many people with it from ever getting diabetes. The strategy includes modest weight loss, increased physical activity, such as walking 30 minutes a day, and choosing a healthier diet. In addition to helping stave off diabetes, these lifestyle changes can also help protect against heart attack, stroke, bone-thinning osteoporosis, and a host of other chronic conditions.

Those efforts are worth it, because diabetes can cause damage throughout the body. Extra glucose (blood sugar) can change the way blood vessels behave, increasing the chances of having a heart attack, stroke, or other form of cardiovascular disease. Diabetes-related damage to small blood vessels can lead to blindness, kidney disease, and loss of feeling. It is a leading cause in the United States of hard-to-treat infections and amputations.

Providing more people with a wake-up call that diabetes may be looming, and heeding that call, could help battle the epidemic of diabetes.