More people becoming at risk for prediabetes

Washington -- The rising tide of obesity is carrying many more people toward diabetes. Fifty-seven million in the U.S. alone now have prediabetes, which raises their risk of developing the chronic disease by three to 10 times, said Daniel Duick, MD, president of the American Assn. of Clinical Endocrinologists at a March 23 Capitol Hill briefing.

Worldwide, the toll rises to 314 million.

People who have impaired glucose tolerance or impaired fasting glucose, the hallmarks of prediabetes, are on a trajectory toward the illness, said Dr. Duick, and the risks of not treating these early conditions are substantial. Complications of diabetes begin early and include such microvascular conditions as retinopathy, neuropathy and nephropathy, as well as cardiovascular disease.

The Centers for Disease Control and Prevention estimates that one of every three people born in 2000 will develop diabetes in his or her lifetime. The risk is greatest among minorities and members of the Pima Indian tribe in Arizona, who have the highest rates of insulin resistance in the world, said Dr. Duick. He practices in the area of the state in which the tribe lives. Research conducted on this community over the past several decades determined that half of Pima Indians have diabetes by the time they are 50.

But there are ways to head off the disease, noted briefing speakers. Many members of Dr. Duick's own family have taken preventive steps, he said, including his father, who lost 50 pounds, thus lowering his risk for diabetes and living to be 90. Along these lines, American Medical Association policy recognizes the health risks posed by obesity in children and adults.

A long period of glucose intolerance that precedes the actual development of diabetes, and screening tests can reveal this susceptibility, said Yehuda Handelsman, MD, the treasurer of AACE.

Among interventions that can lower risk are weight loss and good control of blood pressure and lipid levels, said Dr. Handelsman. Blood pressure below 130/80 mm Hg and LDL levels of 100 mg/dL or lower should be goals.

A 5% to 10% weight loss and physical activity of moderate intensity for 30 to 60 minutes five times a week, as well as a diet that includes increased fiber intake and, perhaps, limits on carbohydrates, should be recommended, said Dr. Handelsman.

These lifestyle changes are remarkably effective at increasing quality-adjusted life years, he said, as well as in reducing the substantial, $13,000 annual cost of treating each person who has the disease.

Since there aren't enough endocrinologists to treat all the people either at risk for or already diagnosed with diabetes, primary care physicians will likely see more such patients, said Jeffrey Garber, MD, AACE president-elect. With this need in mind, AACE has begun a Diabetes Education Initiative for primary care physicians that covers the diagnosis and management of type 2 diabetes, he said.

Since its start in 2004 in California, more than 2,500 physicians and other health care professionals have attended the half-day program. Plans are in place to introduce it in 19 additional states, plus the District of Columbia, in coming years.