Skip to content

Tag: prediabetes

Published on Leave a comment on Controversies With the Prediabetes Diagnosis

Did you know that the issue of prediabetes and what it actually means for health is controversial among some physicians and medical groups? Elevated blood sugar was once considered a risk factor for type 2 diabetes, but now it has been elevated into a pre-disease called prediabetes. We are now told that 1 out of 3 Americans are pre-diabetic and 90 percent of us don’t even know it. The main issues are: What does a prediabetes diagnosis mean? Does prediabetes lead to diabetes? How frequently does this occur? Should one treat it with medications? When one thinks about risk factors - then they can usually be modified (e.g. diet, weight loss, exercise), but when something is called a pre-disease - then one thinks treatment (e.g. medicines).

Yes, we all agree that type 2 diabetes is a very serious health problem. But what about prediabetes? What is alarming to some researchers is that the definition of prediabetes has been broadened over the years to include millions more Americans. Also, what is considered prediabetes in the US may not be considered prediabetes in other countries. Keep in mind that the people most involved with promoting a broadening definition of prediabetes and promoting drugs to treat it, have a number of conflicts of interest (financial and scientific).

The site Health News Review covered the topic of prediabetes in Jan. 2017 in a post by Dr. Michael Joyce: BMJ:Can we trust the numbers that define pre-diabetes? Some quotes from that post: "...a meta-analysis of the progression rates of pre-diabetes shows the majority of people did NOT go on to develop diabetes a decade later."  "...in an article published in the BMJ, the accuracy of screening for pre-diabetes with fasting blood sugar and glycated hemoglobin is brought into question." ... “Our research looked at both these tests for pre-diabetes and found that neither of them was accurate,” says lead researcher Dr. Trisha Greenhalgh .... "In short, both our ability to predict diabetes with blood tests alone, and do so accurately in people with borderline elevated blood sugars, is questionable. Nonetheless, results from these tests – sometimes interpreted without clinical context – are being used to medicalize a risk factor and create a new medical condition."  Yikes!

This past week another thought-provoking article discussed the topic of prediabetes. Note that some experts call the focus on aggressively treating prediabetes as "scaremongering", especially because those promoting aggressive treatment the most are those with conflicts of interest. Centers for Disease Control and Prevention (CDC) data show that progression from prediabetes to diabetes is actually less than 10% in 5 years, and other studies show even slower (lower) rates. And a comprehensive 2018 Cochrane review of studies found that "up to 59% of prediabetes patients returned to normal glycemic values over 1 to 11 years with no treatment whatsoever". (see below) Wow! Excerpts from the article by Charles Piller in the journal Science:

Dubious Diagnosis

A war on "prediabetes" has created millions of new patients and a tempting opportunity for pharma. But how real is the condition?

The most common chronic disease after obesity, afflicting 84 million Americans and more than 1 billion people worldwide, was born as a public relations catchphrase. In 2001, the PR chief of the American Diabetes Association (ADA) approached Richard Kahn, then the group's chief scientific and medical officer, for help with a vexing problem, Kahn recalls. ADA needed a pitch to persuade complacent doctors and the public to take seriously a slight elevation in blood glucose, which might signal a heightened risk of type 2 diabetes. Raising the alarm wasn't easy, given the condition's abstruse name, impaired glucose tolerance, and lack of symptoms.  ...continue reading "Controversies With the Prediabetes Diagnosis"

Published on

Excerpts from an article by Jane Brody in the NY Times:

Beating Back the Risk of Diabetes

This year, nearly two million American adults and more than 5,000 children and adolescents will learn they have a potentially devastating, life-shortening, yet largely preventable disease: Type 2 diabetes. They will join 29.1 million Americans who already have diabetes.

Diabetes and its complications are responsible for nearly 200,000 deaths a year; the fatality rate among affected adults is 50 percent higher than among similar people without diabetes. Alarmingly, recent studies even have linked diabetes to an increased risk of dementia and Alzheimer's disease. Even people with above-average blood glucose levels, but not diabetes, have an elevated risk.

The Diabetes Prevention Program study, conducted among about 3,800 people who had pre-diabetes, found that moderate weight loss — an average of 12 pounds —  reduced the odds of progression to diabetes by nearly 50 percent.

An excellent discussion of what is known about the effect on diabetes of various foods and supplements appeared recently in Nutrition Action Healthletter at cspinet.org/iceberg.pdf. Some highlights:

Carbohydrates - breads, grains, cereals, sugary drinks and sweets of all kinds — are most problematic for people with diabetes or at risk of developing it. Carbohydrates are eventually metabolized to glucose, which raises the body’s demand for insulin. Consume less of them in general, and choose whole-grain versions whenever possible.

If you must have sweet drinks, select artificially sweetened ones. In two huge studies of nurses and other health professionals who were followed for 22 years, those who drank one or more sugary soft drinks a day had about a 30 percent higher risk of developing diabetes than those who rarely drank them, even after their weight was taken into account.

But there’s good news about coffee. Two or three cups of coffee (but not tea) a day, with or without caffeine, have been consistently linked to a lower risk of Type 2 diabetes. 

For protein, limit consumption of red meat, especially processed meats like sausages, hot dogs and luncheon meats, which are linked to a higher diabetes risk. Instead, choose fish, lean poultry (skinless and not fried), beans and nuts. Low-fat dairy products, including yogurt, and even fatty ones may lower the risk of diabetes; the reason is unclear.

Most protective are green, leafy vegetables — spinach, chard, kale, collards, mustard greens and even lettuce — as well as cruciferous vegetables like cabbage, broccoli and cauliflower. But all vegetables are good and should fill at least two-thirds of your dinner plate.

The nutrients magnesium and vitamin D are also potentially protective. In fact, the preventive value of leafy greens, whole grains, beans and nuts may lie in their high magnesium content. In a well-designed clinical trial of 32 overweight people with insulin resistance, the prelude to diabetes, blood glucose levels and insulin sensitivity improved in those who took a daily magnesium supplement for six months. Don’t go overboard: More than 350 milligrams of magnesium daily can cause diarrhea. 

Vitamin D, long known to be crucial to healthy bones, may also be helpful. In one study of 92 overweight or obese adults with prediabetes, those who took a supplement of 2,000 international units of vitamin D daily had better function of the pancreatic cells that produce insulin..

Of course, how much you weigh and what you eat are not the only concerns. Regular, preferably daily, physical exercise is a vital component of any prevention and treatment program for Type 2 diabetes, or most any chronic ailment. Weight loss can reduce diabetes risk by about 50 percent, but adding exercise to that can lower the odds by 70 percent, compared with people who remain overweight and inactive, according to a study that followed nearly 85,000 female nurses for 16 years. Women who were active for seven or more hours weekly had half the risk of developing diabetes as did women who exercised only a half-hour a week.