Latest estimates show there are now 29 million people with diabetes, even though about 8 million of those people do not even know they have it (1). This is twice what the number was 20 years ago when I first became an educator. That sounds like a lot of people, that is until you consider the estimated number of people that have pre-diabetes. That number now stands at 86 million (1). Approximately 2.5 times as many people have pre-diabetes as diabetes, and sadly I fear most of these people will end up with Type 2 diabetes.
I predict this because most of those diagnosed with pre-diabetes are not well enough informed as to what they need to do to prevent getting worse and later going on to develop Type 2 diabetes.
To be clear, pre-diabetes is diagnosed when a person's fasting blood glucose level (has not eaten or drank in at least eight hours) is between 100 mg/dl and 125 mg/dl (2). When someone has been diagnosed with pre-diabetes they do not have diabetes, yet, however they are on their way (normal fasting blood glucose levels are less than 100 mg/dl) (2).The good news is that there are now studies that show that if people with pre-diabetes make some significant lifestyle changes they may be able to normalize their blood glucose levels and not progress to having Type 2 diabetes (3,4).
Pre-diabetes is reversible, Type 2 diabetes is not
A key point to realize here is that pre-diabetes in many cases can be corrected, or reversed if you like to think of it that way, and Type 2 diabetes never develops. If corrective measures (lifestyle improvements) are not made while pre-diabetic and pre-diabetes progresses to Type 2 diabetes, that is not reversible. Once you have Type 2 diabetes you will have it forever. There is no going back. After your diagnosis you may do a great job of taking care of your diabetes, in fact your blood glucose levels may be normal most of the time even without any diabetes medication, but you still have diabetes, and any time you get careless with your self care your blood glucose levels will rise.
It is so very important that people diagnosed with pre-diabetes do something about it as soon as they are diagnosed to see if they can prevent it from turning into Type 2 diabetes. Sometimes private insurance will cover diabetes education for people that have been diagnosed with pre-diabetes. Considering what's at stake here it is always worth a call to the insurance company to see if they will cover the cost of a comprehensive diabetes class. Enrolling in a comprehensive diabetes education class is probably the first and most important thing to do after being diagnosed.
Don't wait until you develop diabetes to do something
A huge mistake that many, many people make, including too many professionals in the health care industry, is that they wait until they actually have been diagnosed with Type 2 diabetes or the person they are treating is diagnosed with Type 2 diabetes before they take any significant action. The diagnosis of pre-diabetes appears to be taken far too lightly by a lot of people. Patients that were once diagnosed with only pre-diabetes that later progressed to developing Type 2 diabetes will tell me when I interview them that three months or maybe six months or even a year or so before developing diabetes they had been diagnosed with pre-diabetes. I always ask them when they tell me this if they made any changes in their lifestyle after finding out they were pre diabetic, or if they did anything as a result of the diagnosis. There are several answers that I hear the most often. By far the most frequent being: "The doctor told me we just need to keep an eye on it." Another frequent response is, "I watched what I ate for a while." And occasionally, " I started walking in the evening."
Pre-diabetes needs to be aggressively treated
When told you have pre-diabetes, that is not a time to be passive and take a let's-see-what-happens attitude. It is a time to leap into action and see if you can prevent Type 2 diabetes. It's a time to ask, "Doc, what can I do to keep this from turning into Type 2 diabetes!" And by all means the doc's response should be more than just, "Let's keep an eye on this for now." Pre-diabetes is in some ways like a ticking bomb. If nothing is done when pre-diabetic it is more than likely only a matter of time before developing Type 2 diabetes. A diagnosis of pre-diabetes is a warning to change direction towards a healthier lifestyle, one that includes being much more physically active and making wiser food choices.
DPP and Da Qing diabetes studies
The Diabetes Prevention Program Trial and the Da Qing Diabetes study are two studies that showed adding 150 minutes of exercise per week to an otherwise sedentary lifestyle and reducing bodyweight by 7 percent could return pre-diabetes blood glucose levels to normal in greater than 50 percent of study participants (3,4).These studies prove that the majority of the people headed towards Type 2 diabetes have a choice in the matter as it does not have to happen, however they need to be made aware of the things they need to do to avoid it.
It is my belief that instead of only working to improve the lives of people with diabetes, we need to put significant effort into preventing people from ever developing the illness. That, I believe is where health care professionals can have the greatest impact. Doctors, nurses, diabetes educators, etc. all have the responsibility to enthusiastically emphasize to their patients at risk for Type 2 diabetes, including those with pre-diabetes, what they can do to prevent it. Unfortunately, I don't think that is always happening now, at least not as often as it should.
Let's work on that.
References:
3. Effects of Diet and Exercise in Preventing NIDDM in People With Impaired Glucose Tolerance: The Da Qing IGT and Diabetes Study / http://care.diabetesjournals.org/content/20/4/537
4. The Diabetes Prevention Program (DPP) Description of lifestyle intervention / http://care.diabetesjournals.org/content/25/12/2165.full