Dr. M. Arthur Charles, M.D., Ph.D

 

Prediabetes can make you sick

Prediabetes is a pandemic, with over 100 million (1 in 3) people in the US and 720 million people worldwide inflicted by the disease. Prediabetes causes serious health problems, such as type 2 diabetes. There are 26 million prediabetic people in the US that will develop type 2 diabetes within 5 years of being diagnosed. The damage to health caused by prediabetes is not only progression to diabetes, but also leads to cardiovascular disease, coronary heart disease, stroke, heart failure, and thus cardiovascular mortality.

What puts you at risk for developing prediabetes?

Age and weight, and genetics are the main factors that put people at risk for getting prediabetes. People who are overweight, with an elevated Body Mass Index (> 30.0 kg/m2) are at significant risk, with 59% developing prediabetes. Age is also a major factor, prediabetes develops in 67% of people at the age of 65 or older.

Early detection of prediabetes can stop diabetes before it starts

Early detection of prediabetes is critical, and can lead to treatments that prevent progression to full blown diabetes and other major health risks. Prediabetes is easy to diagnose, by testing fasting blood glucose levels, and A1c levels. Normal healthy individuals fasting glucose levels are typically in the range of < 85 mg/dL , whereas prediabetic levels are greater than 80-90 mg/dL. The A1C test, also known as the hemoglobin A1C test, measures average blood sugar level over a period of three months. It is used to diagnose diabetes and prediabetes. Normal A1C levels are below 5.7%, whereas prediabetes A1C levels are between 5.7% and 6.4%. People with diabetes have A1c levels of 6.5% or higher. It has been suggested based on clinical observations, that fasting glucose above baseline (85 mg/dL) is sufficient evidence to begin preventative treatment of weight loss, and if A1c>5.7 weight loss and medication.

A broad screening approach is necessary to identify and treat prediabetics

There are reasons to have a more aggressive campaign to identify people at early stages of prediabetes. Prediabetes is a significant health problem with a clear early asymptomatic stage, and there are suitable and acceptable diagnostic tests. In addition there is an accepted therapeutic treatment for patients diagnosed with the disease. A major percentage of people in the US are prediabetic and many will develop associated morbidity and mortality. Overall a broad screening approach is justified.

Treatment of prediabetes can prevent progression to diabetes

Clinical trials have shown that taking the drug Metformin and improving diet and exercising will stop progression of prediabetes into serious health complications. In a study published in the New England Journal of Medicine, nondiabetic persons with prediabetes were divided into three treatment groups, 1) non-treated, 2) those taking metformin twice daily; or 3) a health-wise lifestyle program. The results were conclusive: Diabetes developed in 11 percent in the non-treated group, and 8 percent in those treated with metformin, and 5 percent in people with improved life-style. To put this information in perspective, in a population of 100 million people with prediabetes, 25 million will develop diabetes within 5 years. Lifestyle changes will prevent diabetes from developing in 14 million people, treatment with metformin would prevent diabetes in 8 million people.
What is shocking, is that despite these findings, in the United States, less than 1% of individuals with prediabetes are involved in national Diabetes Prevention Programs, and fewer than 4% of US individuals with prediabetes have been prescribed metformin.

Prediabetes is serious, but reversible: Here’s what everyone needs to know

Surprisingly, of over 100 million American adults that have prediabetes, 81% are not aware they have it. Diagnosis of prediabetes is not difficult. Treating millions of prediabetics will substantially reduce the individual and public health burden of diabetes. The challenge seems to be a lack of awareness, or interest, of the public, government, pharmaceutical industry, advocacy organizations, and health care providers. A number of changes can be implemented at the personal, social and public levels. For example, promotion of diabetes prevention programs by structurally revised Public Health Departments at the directions of the revised Centers for Disease Control and Prevention (CDC). At a practical level public awareness must increase and health care providers must be educated about how to diagnose prediabetes and develop a treatment plan. This particularly applies to Public Health Department nurses trained to care for prevention of lifestyle disorders using dedicated, real time and interactive electronic medical records to achieve health care systems for effective prevention.

Conclusion

Clearly, the prediabetes pandemic can be resolved to the benefit of all, primarily through early diagnosis, and appropriate lifestyle intervention and medication. The foundation of success however will be educating the masses about the chances of having prediabetes, how prediabetes leads to major health problems, and that it can be treated.

About the Author

Dr. M. Arthur Charles is a clinical professor in the Department of Medicine at the University of California San Francisco, was director of the focused Research Program in Diabetes at UC Irvine and a senior consultant to the Diabetes Research Center & Atherosclerosis Prevention Center in Tustin, California. A noted clinician, researcher, and teacher for more than 50 years, Dr. Charles has helped develop diabetes clinics in Russia, Vietnam, and China. Dr Charles is the author of: Diabetes Management: Complication Risk Assessment, Diagnosis, and Therapeutic Options. Mary Ann Liebert Publishing, 2020; , and The Origins Of Diabetes: The Irrelevant Pandemic, 2023.

References

  1. Charles MA. The Origin of Diabetes: The Irrelevant Pandemic. 2023. ISBN-13 ‏ : ‎ 979-8853099265. See: https://www.amazon.com/Origins-Diabetes-Irrelevant-Pandemic/dp/B0CCCVG9RH

  2. Charles MA, Leslie RD. Diabetes: Concepts of β-Cell Organ Dysfunction and Failure Would Lead to Earlier Diagnoses and Prevention. Diabetes. 2021 Nov;70(11):2444-2456. doi: 10.2337/dbi21-0012. PMID: 34711669; PMCID: PMC8564410.

  3. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM; Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002 Feb 7;346(6):393-403. doi: 10.1056/NEJMoa012512. PMID: 11832527; PMCID: PMC1370926.

  4. Chan JCN, Lim LL, Wareham NJ, Shaw JE, Orchard TJ, et. al. The Lancet Commission on diabetes: using data to transform diabetes care and patient lives. Lancet. 2021 Dec 19;396(10267):2019-2082. doi: 10.1016/S0140-6736(20)32374-6. Epub 2020 Nov 12. Erratum in: Lancet. 2021 Dec 19;396(10267):1978. doi: 10.1016/S0140-6736(20)32679-9. PMID: 33189186.

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