Women's Heart Advisor January 2013 Issue

Is Prediabetes Looming Within?

Get to know the quiet condition you can control, and the one that should be seen as a warning to start making lifestyle changes immediately.

The numbers are ominous: 79 million adult Americans have “prediabetes.” A condition in which blood glucose levels are higher than normal, but not high enough to be diagnosed as diabetes, prediabetes often has no signs or symptoms. As it quietly looms, people with prediabetes are unaware they are five to 15 times more likely to develop diabetes and numerous other health complications as a result.

FPG (Fasting Plasma Glucose) and OGTT (Oral Glucose Tolerance Test) are blood glucose level checks that can determine your risk of diabetes. Have them tested yearly.

Although the prediction surrounding prediabetes sounds grim, the good news is that the progression to diabetes can be stopped. But, how do you know if you’re at risk? Cleveland Clinic specialists say it’s all about awareness.

“People with prediabetes are not full blown diabetics, but their health is not normal either. In this ‘in-between’ stage they may only have vague signs that something is wrong, such as feeling fatigued after eating or gaining weight without eating more than usual,” says endocrinologist Betul Hatipoglu, MD. “The overall increased rate of diabetes, especially in women, makes it more important to take simple, proactive steps to improve your health for prevention.”

Who’s at risk?
Today, a relatively sedentary lifestyle along with eating a high-calorie and high-carbohydrate diet is considered normal. Yet, this combination requires more of the hormone insulin (that comes from the pancreas) to help glucose (digested sugars and carbohydrates) enter the cells and be used for energy. Over time, the pancreas can’t make all of the insulin a person needs or the body doesn’t use the insulin correctly (insulin resistance), causing prediabetes to set in.

While the exact cause of prediabetes is unknown, excess fat and inactivity seem to be important factors in its development. Other risk factors include advanced age, family history and lack of sleep. Additionally, people of certain races, including African-Americans, Hispanics, American Indians, Asian Americans and Pacific Islanders are more likely to develop prediabetes.

“There is also an increase of prediabetes in women from being overweight due to fluctuating hormones, and the difficulty to lose weight following pregnancy,” explains Dr. Hatipoglu, a staff member in the Department of Endocrinology, Diabetes and Metabolism.

Yet, even thin women are at risk. “We have been so overwhelmed with the rise of obesity that we totally ignore the fact that women can be a normal weight and still have prediabetes due to other risk factors. A normal weight doesn’t always mean a healthy environment,” warns Dr. Hatipoglu.

Heading off a silent threat
Preventing prediabetes from developing into type 2 diabetes should be taken seriously. Recent research suggests that hyperglycemia (high blood sugar) injures the heart and an additional study showed high blood sugar lowers the chances of surviving a heart attack.

“Hyperglycemia is a known risk factor for increasing inflammation and vessel changes that can lead to heart attack and stroke,” explains Leslie Cho, MD, Director of Preventive Cardiology and Rehabilitation at Cleveland Clinic.

“Prediabetes is a disease that can lead to many other manifestations, including heart disease, stroke and kidney and eye disease. It’s not just about a simple hemoglobin A1C test number on a page—it’s about your overall mortality,” Dr. Hatipoglu says. “Prevention is all up to the patient.”

Dr. Cho agrees. “For my patients with prediabetes, I send them to a nutritionist as well as an exercise physiologist to design an exercise program tailored to their needs. Then, I follow up with them in two to three months to make sure they are on the right track,” she says.

The most powerful way to prevent prediabetes is through diet and exercise. A study by the Diabetes Prevention Program Research Group showed that people with prediabetes slashed their risk of developing diabetes by more than half if they lowered the fat and calories in their diet, boosted exercise and lost weight. Additionally, type 2 diabetes can be delayed or avoided by losing just five to seven percent of a person’s body weight, according to the Centers for Disease Control’s National Diabetes Prevention Program.

“Exercise can change your fate and alter your metabolism back to a non-diabetic environment,” Dr. Hatipoglu. “The best part of my job is that if a patient has prediabetes, we can actually do something to reverse it. A simple blood test through your physician can change a patient’s life.”