Prediabetes has finally been recognized as a significant problem because diabetes is a progressive disease, says Dr. James Anderson, medical director, PTS Diagnostics.
“Unlike breaking a bone, where you are fine one minute and then in pain and need an orthopedic surgeon the next, type 2 diabetes is a progressive disease, often developing over a long period – seven to 10 years – before it is clinically diagnosed.”
The American Diabetes Association estimates that over 90 million Americans have prediabetes, which, says Anderson, “is that period of time when your glucose and lipid metabolism is no longer normal, but does not yet meet the clinical diagnostic criteria of diabetes mellitus.” Commonly in prediabetes, the fasting blood glucose may be normal or near normal, but the glucose rises higher after a meal (post-prandial hyperglycemia) than in a person without prediabetes, he says. In these cases, the fasting blood glucose may be normal, but the hemoglobin A1c is elevated.
The connection between prediabetes and diabetes is accepted by most clinicians, says Anderson. “While unusual to have all clinicians ever completely agree with one another on any issue, most would agree that there are physiologic and histologic changes associated with prolonged elevations of average blood glucoses most easily demonstrated by the increased irreversible binding of glucose to the hemoglobin molecule resulting in an elevated HbA1c,” he says.
“All persons with type 2 diabetes have progressed through a period of prediabetes. But, as studies have shown, some patients with prediabetes do, with lifestyle changes, reverse the progression, remaining in the prediabetes category or even returning to normal glucose metabolism. So, yes, not all persons with prediabetes become persons with type 2 diabetes. However, having prediabetes that does not progress to diabetes does not mean the individual is healthy.”
Recognizing prediabetes is important because several new studies, as well as programs from the CDC and YMCA, have demonstrated that if the person with prediabetes makes changes to their lifestyle by following good meal planning, achieving weight loss, and increasing physical activity, they can delay, or even prevent, the onset of type 2 diabetes, says Anderson. This can also result in delaying and reducing the severity of the complications of diabetes (e.g., atherosclerotic heart disease, stroke, kidney damage, visual loss, and peripheral neuropathy), which cause the morbidity and mortality of diabetes.
Weight reduction is the key to successful treatment of prediabetes, as well as improving the outcomes of persons already diagnosed with type 2 diabetes, he continues. “Sensible meal planning and even moderate increases in physical activity are the most effective tools in achieving long-term weight loss. A 10 percent loss in body weight will result in significant improvements in the fasting blood glucose, the post-meal rises in glucose and the HbA1c. While repeated HbA1c measurements have not been the standard of care in many of the CDC and YMCA programs to date, the reduction in HbA1c in persons successful in losing weight is another positive reinforcement and motivation to continue the program.”
Message for reps
A presentation at the annual Scientific Sessions of the American Diabetes Association in June 2016, titled “Failure of Fasting Blood Glucose Screening to Detect All Persons with Diabetes or Pre-diabetes,” by J H Anderson, et.al., demonstrated that in a group of 22,498 individuals, 12 percent had an HbA1c of 5.7 percent or greater (indicating prediabetes) but a fasting glucose of 100 mg/dL or less (a normal FBG), says Anderson. “This illustrates the potential value of using the HbA1c, rather than fasting glucose, to identify persons with prediabetes who could benefit from programs of lifestyle management.
“As with all medical devices, the distributor sales representatives should know their products, the quality, the use, the advantages and limitations, and the clinical/scientific values to both the medical community and potential patient populations,” he says. “Technology has the advantage of moving faster than medical textbooks, government panels, and, often, even the newspaper headlines, so the sales representative as a member of the healthcare team has to bridge those gaps to ensure the best in health care delivery the patient.”