Prediabetes is a major problem, affecting one-third of all adults in the United States. A preventive program can cut the risk of developing diabetes by half. Although medications can help some people with prediabetes, they are not recommended for most people. The keys to prevention are diet and exercise, especially losing weight.

The number of adults in the United States with diabetes has increase from 15.4 million to 29.1 million over the past 10 years. About 9 percent of adults have diabetes. Even worse, one adult in three or 86 million people have a condition many people have not even heard about called prediabetes. Prediabetes occurs when the blood sugar is higher than normal, but less than the level for diabetes.

The most common test to diagnose diabetes is a fasting blood sugar. A normal fasting blood sugar is less than 100 mg/dl. A blood sugar of 126 mg/dl is used to diagnose diabetes. A fasting blood sugar of 100-125 mg/dl indicates prediabetes.

Prediabetes normally causes no symptoms and is best diagnosed by testing. Risk factors for prediabetes include: brother, sister or parent with diabetes; obesity; getting little or no exercise and age 65 or older. Prediabetes should be taken very seriously. About 70 percent of people with prediabetes will eventually develop diabetes.(Tabak).

Losing weight is the first key to preventing diabetes. In the US Diabetes Prevention Program, people who reduced their weight by 5-7 percent decreased their chance of developing diabetes by 58 percent. General advice for healthy eating while losing weight includes eating fruits, vegetables, whole grains and low fat protein while avoiding sugar and high fat protein.

Regular exercise is the second key to preventing diabetes. The American Diabetes Association advises 30 minutes a day at least 5 times a week of brisk walking, swimming, dancing or similar activities. Increasing activity during the day by taking the stairs, parking farther away or other opportunities is also advised. One common goal is 10,000 steps a day measured by a pedometer.

Medications are also used for selected high risk patients. The most common medication prescribed is metformin. It works best for patients who have higher sugars and are obese.   Although other medications are effective, they are rarely used due to risks and side effects.

The risk of developing diabetes can be cut in half with a prediabetes program. To accomplish this requires a significant commitment. A certified Center for Disease Control and Prevention Diabetes Prevention program requires at least 22 classes spread over one year. If you are interested, a curriculum is available at http://www.cdc.gov/diabetes/prevention/recognition/curriculum.htm.

Next Month: Why are so many people obese?

Key References

1. Center for Disease Control and Prevention.   Diabetes Home – http://www.cdc.gov/diabetes/data/national.html
2. NIH National Institute of Diabetes and Digestive and Kidney Diseases http://www.niddk.nih.gov/health-information/health-topics/Diabetes/insulin-resistance-prediabetes/Pages/index.aspx
3. Tabák AG, Herder C, Rathmann W, Brunner EJ, Kivimäki M: Prediabetes: A high-risk state for developing diabetes. Lancet. 2012 Jun 16; 379(9833): 2279–2290.
4. American Diabetes Association. Physical activity. http://www.diabetes.org/are-you-at-risk/lower-your-risk/activity.html
5. National Diabetes Prevention Program. Get the curriculum. http://www.cdc.gov/diabetes/prevention/recognition/curriculum.htm