About 24 million Americans have diabetes. In addition, the Centers for Disease Control and Prevention (CDC) estimate that 57 million Americans have pre-diabetes. This means that about 27% of the population is at risk for developing diabetes. Pre-diabetes is defined as impaired fasting blood glucose between 100 and 125 mg/dl, impaired glucose tolerance of 140 to 199 mg/dl, or both. Between 6 and 10% of patients with impaired glucose tolerance and about 60% of patients with both impaired fasting blood glucose and impaired glucose tolerance will develop diabetes. A diabetes task force of the American College of Endocrinology declared in a consensus statement that the treatment of pre-diabetes requires intensive lifestyle modifications and the use of metformin and acarbose to prevent diabetes in high-risk patients.

The preferred treatment for the abnormalities of these groups is intensive lifestyle management because of its effectiveness and safety. Research done in China showed that intensive lifestyle interventions over a 6-year period decreased the incidence of diabetes by 51% over the next 14 years, demonstrating that lifestyle interventions have long-term effects on the risk of developing diabetes. This approach has proven effective for controlling blood glucose levels and reducing cardiovascular risk factors. The task force recommends pre-diabetes patients lose 5 to 10% of their body weight. They suggest self-monitoring, setting of realistic goals, stimulus control, cognitive strategies, social support and appropriate reinforcement as tools to help with weight loss. They also recommend 150 minutes of moderate intensity exercise such as walking or biking every week. Another recommendation is to limit saturated and trans-fats.

For high-risk patients, those with worsening glucose control, cardiovascular disease, or nonalcoholic fatty liver disease, medication should be considered in addition to lifestyle modification. Medications to be used include metformin and acarbose to control blood glucose, statins to reduce cholesterol levels, aspirin to improve circulation, and ACE inhibitors or ARBs to lower blood pressure. Goals of therapy are the same for those with diabetes and pre-diabetes.

Monitoring recommendations were also issued to watch for worsening conditions. Annual glucose tolerance and micoalbuminuria tests, twice yearly fasting blood glucose, A1c, and lipid profiles are recommended. The task force stated that insurance companies should pay for prevention measures and lifestyle intervention programs, as the costs of prevention will be made up by decreased treatment costs for diabetes.

The total health and wellness center of Taos is your disease prevention resource. Call Jake or Becky at (575) 737-5810 to schedule your diabetes risk assessment or for lifestyle modification recommendations.

Reference: http://www.diabetesincontrol.com/results.php?storyarticle=5959.

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