Prediabetes – Can You Avoid It?

October 2, 2018 in Diabetes Management, Uncategorized by Joyce Bunderson

Essentially, prediabetes is when blood sugar is higher than normal, but not high enough to be diagnosed with Type 2 diabetes. The big snag with prediabetes is that nine out of ten of those with prediabetes don’t know they have it; and a third of American adults have it.

Why should you care? Most people just think of diabetes as a blood sugar problem; but in reality, diabetes/prediabetes is a metabolic disorder that affects the blood vessels, the heart, the liver and the nervous system. It’s definitely something to be avoided if at all possible.

Helping people avoid diabetes is exactly what the Diabetes Prevention Program (DPP) set out to do. In one study they randomly assigned each of about 3,200 overweight people with prediabetes into one of three groups. One took Metformin (a drug that lowers blood sugar). Another was a control group given a placebo. The third group was instructed and performed a lifestyle-altering program (diet and exercise) (see NEJM. 346: 393,2002). The researchers stopped the study after only one year, because the lifestyle group had a 58 percent lower risk of diabetes than the placebo group. There are ethical rules about continuing research when the outcome is so blatant. (Note: Similar results were found in studies in Europe and Asia – see Annals of Internal Medicine 163: 437, 2015.)

The Metformin group cut the risk of getting diabetes by 31 percent; but those in the lifestyle group (diet and exercise) dropped by 70 percent. Amazing! The weight loss was minimal and the exercise was only 150 minutes a week. The point is that lifestyle (which is so non-invasive compared to medicines) has been shown to lower the risk of diabetes.

Quite a bit of time has gone on since that research; and now there are DPPs all over the country. Just this year, Medicare has begun covering the programs. Also, if the programs meet certain criteria set by the Centers for Disease Control and Prevention, they’re covered by some insurance plans.

The Mediterranean style of eating, which I write about so frequently, is a way of eating that can reduce your risk of developing diabetes. (The PREDIMED Study, which I’ve written about before, found a 52 percent lower risk of developing diabetes.) People who consume a Mediterranean-style of eating have less incidence of metabolic syndrome, reduced risks of heart attacks, stroke and even dementia (all problems that are increased for those with prediabetes and Type 2 diabetes. I know I’ve shared this style of eating too many times before, but I’ll just briefly recap here: Mostly eat whole foods and minimally processed foods; lots of vegetables; legumes/beans; fruits; and whole grains. Nuts, seeds, olive oil and fish are eaten frequently.

As almost a postscript, I’d like to share something that I recently observed. A friend of mine’s husband has been struggling with prediabetes for quite some time. His doctor put him on Metformin because of his prediabetes. He did see some improvement in his numbers after taking the medication. Now here’s my observation: Physicians are trained to give medicine. Although the medicines are not without risks of their own, it’s easier to put a person on a medication than to refer to a DPP. I personally feel it’s less than perfect to jump straight to Metformin, without even giving diet and exercise a try – not to mention again, the risk reduction difference (lifestyle 70% reduction; Metformin 31% reduction).

Personally, I strongly advocate a low sodium Mediterranean style of eating and moderate exercise. I’d recommend it anytime over taking meds, and the evidence is certainly strong in the case of Metformin. Find out how your blood sugar is running and then have a serious discussion with your own physician – avoid developing diabetes if at all possible.