Wednesday, April 24, 2002

Warning about 'pre-diabetes'

Health and Human Services Secretary Tommy G. Thompson recently warned Americans of the risks of "pre-diabetes," a condition affecting nearly 16 million Americans that sharply raises the risk for developing type 2 diabetes and increases the risk of heart disease by 50 percent.

HHS-supported research shows that most people with pre-diabetes will likely develop diabetes within a decade unless they make modest changes in their diet and level of physical activity, which can help them reduce their risks and avoid the debilitating disease.

"The good news is if you have pre-diabetes, you can do something about it," Secretary Thompson said. "We want people to know that pre-diabetes is a serious condition that can be reversed or alleviated with modest changes in their daily routines such as eating fewer calories and walking regularly for exercise."

Secretary Thompson and American Diabetes Association (ADA) President-Elect Dr. Francine Kaufman also unveiled an expert panel's new recommendations about pre-diabetes. The panel, convened by the ADA and HHS, calls for physicians to begin screening overweight people age 45 and older for pre-diabetes.

In addition, Secretary Thompson released an updated HHS estimate showing 17 million Americans suffer from diabetes an increase of 8 percent from the most commonly used previous estimate. The new estimate is based on population changes in the most recent U.S. census.

HHS and the ADA are using the new term "pre-diabetes" to describe an increasingly common condition in which blood glucose levels are higher than normal but not yet diabetic known in medicine as impaired glucose tolerance or impaired fasting glucose. Studies have shown that most people with this condition go on to develop type 2 diabetes within 10 years.

The panel which includes doctors and other diabetes experts, with representatives from HHS' National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and Centers for Disease Control and Prevention (CDC) stated that intervention in pre-diabetes is critical for three reasons. First, simply having blood glucose levels in the pre-diabetes range puts a person at a 50 percent greater likelihood of having a heart attack or stroke. Second, research shows that the development of type 2 diabetes can be delayed or prevented through modest lifestyle improvements. Third, for many people, modest lifestyle improvements can "turn back the clock" and return elevated blood glucose levels to the normal range.

"This new recommendation gives physicians added incentive to screen their middle-aged, overweight patients for both type 2 diabetes and pre-diabetes," Dr. Kaufman of the ADA said. "If you have pre-diabetes, you need to know it, so you can learn about the high risk of getting diabetes and the steps you can take to prevent it. If you already have diabetes, you need to be treated early to prevent complications."

The panel recommended that doctors screen overweight people age 45 and older for pre-diabetes during regular office visits using either one of the standard tests that detect diabetes: the fasting blood glucose test, which identifies impaired fasting glucose, or the oral glucose tolerance test, which identifies impaired glucose tolerance.

The panel also recommended that physicians consider screening adults younger than age 45 if they are significantly overweight and have one or more of the following risk factors:

Family history of diabetes.

Low HDL cholesterol and high triglycerides.

High blood pressure.

History of gestational diabetes or gave birth to a baby weighing more than 9 pounds.

Belong to a minority group (African-Americans, American Indians, Hispanic Americans/Latinos, and Asian American/ Pacific Islanders are at increased risk for type 2 diabetes).

The expert panel did not recommend routine use of prescription drugs as initial treatment for people who have pre-diabetes. However, it did suggest that some people benefit from drug therapy, which may be considered when appropriate.

The recommendations resulted from the panel's analysis of several major studies that evaluated strategies to prevent type 2 diabetes, including HHS' Diabetes Prevention Program a major clinical trial involving more than 3,000 people that showed prevention efforts can be effective. The Diabetes Prevention Program found that diet and exercise resulting in a 5- to 7-percent weight loss lowered the incidence of type 2 diabetes by 58 percent. Participants lost weight by cutting fat and calories in their diet and by exercising (most chose walking) at least 30 minutes a day, 5 days a week.

"About 16 million people in the country have pre-diabetes and most of them don't know it," said panel member Dr. Judith Fradkin of NIDDK, which is part of HHS' National Institutes of Health (NIH). "Now that we have shown that we can prevent or delay diabetes, we need to find the people who can benefit. These new practical recommendations can help."

The panel's recommendations will be published in the ADA's Diabetes Care, a peer-reviewed journal of clinical research focused on the nation's fifth deadliest disease. The recommendations come as the incidence of obesity continues to rise despite growing evidence about its adverse effects on health and survival. In the United States, nearly 60 percent of adults are now considered significantly overweight, and in adolescents the prevalence of obesity has nearly tripled in the past 20 years.

As part of Secretary Thompson's announcement, HHS provided copies of ADA's diabetes risk-assessment tool, "Could You Have Diabetes and Not Know It?" to HHS workers. The questionnaire allows users to roughly assess their risks for diabetes quickly. Of the estimated 17 million people with diabetes in the U.S., about 5.9 million are undiagnosed.

Diabetes is a disorder of metabolism in which people have problems converting food to energy. It is the leading cause of adult blindness, kidney failure, and non-traumatic amputations, and a major cause of heart disease and stroke.

More information about research and recent advances related to diabetes is available at <http://www.niddk.nih.gov>http://www.niddk.nih.gov or by calling NIDDK's National Diabetes Information Clearinghouse at 1-800-860-8747. Consumer information about diabetes is also available through the National Diabetes Education Program, an effort sponsored jointly by NIH and HHS' Centers for Disease Control and Prevention, and 200 public and private partners, at http://www.ndep.nih.gov/. Information about diabetes statistics and state programs is available at http://www.cdc.gov/diabetes or by calling 1-800-CDC-DIAB (1-800-232-3422).

More information about the ADA is available at http://www.diabetes.org or by calling 1-800-DIABETES (1-800-342-2383).