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Many Americans may be living with the precursor condition to type 2 diabetes without even knowing it, according to a report released July 18, 2017, by the CDC. The National Diabetes Statistics Report found that more than 84 million people in the United States likely have prediabetes — higher-than-normal blood sugar levels.

Prediabetes can turn into full-blown type 2 diabetes — meaning the body doesn't respond to insulin, a hormone that helps cells absorb blood sugar for energy. Type 2 diabetes increases the risk for vision loss; heart disease; stroke; kidney failure; amputation of toes, feet, or legs; and even early death. The report found that almost one in four people with diabetes is undiagnosed.

Mounting evidence suggests that eating nuts and seeds daily can lower your risk of diabetes and heart disease and may even lengthen your life.

If your idea of healthy eating was formed a few decades ago, it may be hard to shake the notion that you should avoid nuts, which are high in calories and fat. But new evidence has overturned that assumption. In fact, a recent analysis of the nation's eating habits and health outcomes suggests that eating too few nuts and seeds is associated with an increased risk of dying from cardiovascular disease or diabetes.

For that study, in the March 7, 2017, Journal of the American Medical Association, researchers from the Tufts Friedman School of Nutrition Science and Policy relied on a model that used data from scores of observational studies on diet and health, including the National Health and Nutrition Examination Surveys, which provided detailed information on Americans' eating habits over the decade ending in 2012. They estimated that in 2012, over 300,000 deaths from heart disease, stroke, or type 2 diabetes — about 45% of all deaths from those conditions — were associated with eating either too much or too little of 10 nutrients.

Millions have prediabetes and don't know it. Here is why it's important to find out and act to lower your diabetes risk.

 Image: © shelma1/Thinkstock

An estimated one out of three American adults is prediabetic, which means blood sugar levels are higher than normal but below the threshold for type 2 diabetes. Yet 90% of these people do not realize they are in this dangerous gray zone.

"You are not going to have symptoms for prediabetes," says Dr. David Nathan, director of the Harvard-affiliated Massachusetts General Hospital Diabetes Center. "Instead, you or your doctor should determine if you have any of the common risk factors, get your blood sugar levels checked to determine if you have prediabetes, and then make the necessary lifestyle changes you need to stop type 2 diabetes from occurring."

Those extra inches around the middle may signal increased fat around abdominal organs and rising health risks.

It's a rare woman over age 50 who has the same waist measurement she had as a teenager. But in the past decade or so, women's waistlines have been expanding regardless of age. A 2014 report from the National Health and Nutrition Examination Survey found that from 1999 to 2012, the average body mass index (BMI) for women age 20 or older held steady. But during the same period, the average female waistline grew slowly and steadily, from 36.2 inches to 37.8 inches. Researchers are still searching for an explanation for this phenomenon, but they do know one thing: increasing waistlines are linked to greater risks for heart disease, diabetes, and osteoporosis.

What's in a waistline?

Regardless of whether your weight has changed over the years, your height is likely to have decreased, the result of declining volume in the intervertebral discs of the spine. As your torso shortens, your abdominal organs have less vertical space to inhabit, so they move horizontally. If you haven't gained weight, an increase of an inch or two around the waist may simply reflect lost height.

In the journals

Low-dose aspirin therapy is standard treatment for people who have suffered a heart attack or stroke to protect them from a second one. But what about people who don't have cardiovascular disease, but do have specific risk factors, such as type 2 diabetes? A study published in the Feb. 14, 2017, Circulation found that low-dose aspirin therapy in fact did not lower this group's risk for heart attack or stroke.

The researchers recruited more than 2,500 people, ages 30 to 85, with type 2 diabetes and randomly assigned them to take either 81 mg or 100 mg of aspirin daily, or no aspirin, for three years. At the 10-year follow-up, they found that the aspirin therapy did not lower risk of either heart attack or stroke compared with taking no aspirin at all. The reason is not clear, but the researchers speculated that people with diabetes might not experience the expected anti-clotting action of aspirin.

For people with diabetes, eating out — whether at a restaurant, a social function, or a friend's home — can be a challenge. Portions can be hefty and packed with calories and saturated fat. When you eat out, it may help to follow these simple guidelines:

• Ask how entrées are prepared, and avoid fried foods or dishes served in heavy sauces or gravies.
• Choose skinless chicken, fish, or lean meat that's broiled, poached, baked, or grilled.
• Get the server's advice to help you select healthy, low-fat dishes. Restaurants are used to dealing with special diets.
• Don't feel obliged to clean your plate. Eat a reasonable portion, and take the remainder home.
• Choose steamed vegetables and salads to accompany your meals. Request low-calorie dressings and toppings, and if they're not available, ask for all dressings, butter, and sauces to be served on the side so you can use them sparingly.
• If you take insulin and you know your meal will be delayed, time your injection appropriately. You may need to eat a roll or piece of fruit to tide you over.
• If you're craving dessert, have some — but split it with someone else.

For more information on the essentials for a healthy diet and managing type 2 diabetes, buy Healthy Eating for Type 2 Diabetes, a Special Health Report from Harvard Medical School.

In preliminary research, sucralose and acesulfame potassium increased insulin levels, although more studies are necessary to determine whether they—or other artificial sweeteners—increase the risk of insulin resistance.