It’s scary to hear that you have “prediabetes.” I know: I’ve now heard this from two doctors.
When you have prediabetes, your body may not be making enough insulin after you eat to control your blood sugar level, or your body might not respond to insulin properly. My doctors gave me a test called hemoglobin A1c, which shows your average blood sugar level for the past 3 to 4 months. You’re home clear if your A1c score is 5.6 percent or less. A score of 5.7 to 6.4 percent puts you in the prediabetes range. At 6.5 percent or above you have diabetes.
If you do hear that you have prediabetes, you’ve been given valuable information few people receive: In 2012, about 37 percent of Americans aged 20 years or older — and 51 percent of American seniors — had glucose levels in that range but didn’t know it.
Prediabetes increases your risk of diabetes and also makes you more likely to get heart disease or have a stroke. Some 9 percent of Americans — around 29 million Americans — already have type 2 diabetes, which is the leading cause of kidney failure, blindness, and amputation, as well as a major cause of heart disease and stroke. The risk factors include obesity, a family history of diabetes, lack of exercise, hypertension, and high cholesterol.
Most of the time, when doctors break the news that you’re on the path to diabetes, they simply tell you to lose weight and get more exercise. My A1c score was 6 percent, and diabetes also runs in my family, as it does for many Americans. My long-time doctor gave me a prescription for metformin (Glucophage), the most common medication for diabetes. A good deal of evidence from large, well-designed trials supports the use of metformin to push off or prevent diabetes. I took the metformin for a year and also increased my exercise dramatically.
I then saw a new doctor for insurance reasons. He scoffed at the idea of taking metformin if you weren’t already diabetic, though I cited the studies. I stopped the metformin and upped my exercise, biking more than a half hour a day.
I again had to change my primary care doctor for insurance reasons, took the test again and again came up pre-diabetic. My new doctor has seen the metformin studies, but he wants me to first try staying off metformin and losing weight by sticking to 1,500 calories a day using a calorie-counting app on my phone.
None of my doctors recommended that I join an organized program for diabetes prevention. However, according to a report commissioned by the Community Preventive Services Task Force, people do much better in programs that provide coaching and support for at least 3 months. The report reviewed 53 studies describing 66 combined diet and physical activity promotion programs, and found evidence that they boosted weight loss and led to lower blood sugar and better cholesterol markers.
“If you exercise and eat better, you’ll reduce your risk of developing diabetes,” said Patrick L. Remington, MD, MPH, coauthor of the recommendation statement on behalf of the task force. But when doctors simply tell “somebody to eat better and exercise, that does not work.”
In the task force survey, half of the participants paid less than $653 to take part in a prevention program. The Centers for Disease Control and Prevention keeps a registry of programs you can look up by state, as well as a list of virtual or online programs, including one from Jenny Craig, one of the better programs for weight loss, according to one study (http://www.ncbi.nlm.nih.gov/pubmed/25844997). Be sure to check local private gyms, YMCAs, and community health centers.
I see five morals to my own story: 1) forcing patients to change doctors because of insurance is a bad way to run a medical care system. 2) Don’t listen to doctors who scoff at you. 3) Do listen to doctors who urge you to exercise and lose weight. 4) Don’t ignore prediabetes. 5) Get support if you need it. Are you good at staying on diets and exercise routines on your own? No? That’s your answer.
August 04, 2015
Janet O’Dell, RN