If you’re experiencing the symptoms of diabetes, then it is likely the prediabetic stage has passed unrecognized – along with the chance to reverse it.
Prediabetes is a condition that goes unnoticed, with as many as 98 million adults walking around with it, according to the Centers for Disease Control and Prevention. This is about 38 percent of the adult population in the United States.
“It is very prevalent,” said Charles Riepenhoff, ambulatory care clinical pharmacist and certified diabetes educator at ProMedica Jobst Medication Therapy Management. “There are a lot of people out there with it, and they don't know they have it.”
The rising numbers of diabetics – in correlation to super-sized lifestyles – circles the globe.
“We are seeing this not only in the western world, but we're also seeing it in the rest of the world as well,” said Dr. Peminda Cabandugama, an endocrinologist for Cleveland Clinic. “It's something of an eye-opener. And when you tie it into the obesity pandemic that we have going on, I think there's a lot of work to be done in this space.”
Prediabetes is when blood sugar levels are elevated but are not high enough to be type 2 diabetes, which is when symptoms become noticeable.
“Over the past five to 10 years, we are seeing more people getting diagnosed at the prediabetes level,” said Jeannie Wagner, a diabetes health educator at Mercy Health, noting that is a call to “interrupt your sitting.”
Though probably not detectable at the level of prediabetes, symptoms of type 2 diabetes can include increased thirst and urination, fatigue, and blurry vision. Other, less well-known, symptoms can include sweating and skin rash.
The best way to track a position on a scale that moves from normal to prediabetic to type 2 diabetes is through annual screenings that measure sugar levels in the blood, according to Mr. Riepenhoff.
“Anyone 35 or over should be screened for diabetes. That is a big gap in our country where that is not happening,” Mr. Riepenhoff said. “In prediabetes, the body is not going to tell you anything is wrong.”
And often, if people have no physical complaints, there is an erroneous conclusion that nothing is amiss, he said.
Be proactive
The first step is awareness of risk for diabetes. The American Diabetes Association (ADA) offers a 60-second type 2 diabetes risk test. It assesses risk factors such as sex, weight, and level of activity. If at high risk, it might be worth considering having a blood sugar test done. There may be an opportunity for an about-face. However, few people give even a passing consideration to their risk factors.
“That has been the whole problem,” said Dr. William Herman, an endocrinologist at Michigan Medicine. “A lot of people with family histories have a sense of risks.”
The next step for a person with a prediabetic condition is to decide the amount of effort one needs to halt the progression to type 2 diabetes, according to Mr. Riepenhoff.
“Every 26 seconds, someone is diagnosed with diabetes. It will take all of us to innovate, collaborate, and improve outcomes for people living with diabetes, and ultimately to find a cure,” said Charles Henderon, CEO of the ADA.
That effort can be made through a healthy diet and physical activity. Mr. Riepenhoff describes those in pharmaceutical terms as Drug #1 and Drug #2.
“Both of those efforts ideally lead to weight loss,” Mr. Riepenhoff said. “Keep those doses up, and we can prevent the progression to type 2 diabetes.”
Studies show that there is a strong correlation between obesity and diabetes, with 85 percent of type 2 diabetics being overweight. Some characterize the condition as a “modern, preventable pandemic.”
“We are seeing diabetes as an epidemic,” Ms. Wagner said. “We've had some people come into the hospital with extremely high blood sugars and not be aware of it.”
She recommends taking advantage of community screenings. A good glucose level is 70 to 99. A reading from 100 to 125 would indicate a prediabetic level. Over 125 veers into the territory of type 2 diabetes.
There also are over-the-counter devices that can help track blood sugar levels. The Dexcom Stelo Glucose Biosensor System, at a cost of $109.99, was approved in March by the U.S. Food and Drug Administration for continuous glucose monitoring. Other monitors may cost as little as $49.99.
“[These devices] can be a powerful tool to help monitor blood glucose,” said Dr. Jeff Shuren, director of the FDA's Center for Devices and Radiological Health. “Giving more individuals valuable information about their health, regardless of their access to a doctor or health insurance, is an important step forward in advancing health equity for U.S patients.”
Ms. Wagner also suggests that knowledge of family medical history is a further step in creating awareness.
“There is more sharing of that now than in previous generations,” she said.
Lifestyle changes
Dr. Herman recommends the National Diabetes Prevention Program's lifestyle change program, a one-year intervention that provides guidance and support for those aiming to invest time and energy in healthy changes.
“We all have the best intentions,” Dr. Herman said. “I try to exercise every day. It is not the easiest thing to do.”
The national program, offered online and in communities throughout the country, can be intensive, with meetings held once a week for the first six months then once or twice a month during the second six months. According to the CDC, research indicates that the risk for developing type 2 diabetes can be reduced by half with the adopted lifestyle changes.
“The other thing I think has been neglected is the whole environment we live in,” Dr. Herman said. “Diabetes is a medical problem and it is a societal problem.”
Studies support the notion that the prevalence of fast food, junk food outlets, and convenience stores that outnumber healthier options contributes to higher risks for developing diabetes. Dr. Herman also pointed to sugary advertisements directed toward children as well as a restaurant culture of giant-sized portions.
Defying those market forces can be overwhelming to any one individual. There are weight loss drugs that are effective, including Wegovy and Ozempic. Metformin is another drug that, in an off-label use, decreases the amount of glucose absorbed from food and made by the liver. It also increases the body's response to insulin. It is a generic, inexpensive drug that companies don't find profitable to advertise, according to Dr. Herman, adding that it can decrease the risk of developing type 2 diabetes by 31 percent. A doctor can provide a prescription as needed.
“A person can delay if not prevent type 2 diabetes,” Ms. Wagner said.
First Published November 24, 2024, 5:00 a.m.
