Diabetes Dateline

HHS Warns the Public About Pre-diabetes Risk

Last spring, the U.S. Department of Health and Human Services (HHS), along with a panel of experts from the National Institute of Diabetes and Digestive and Kidney Diseases, the Centers for Disease Control and Prevention, and the American Diabetes Association, provided new testing recommendations for pre-diabetes, also called impaired glucose tolerance or impaired fasting glucose. In people with this condition, blood glucose levels are higher than normal but not high enough to be diagnosed as diabetes. Pre-diabetes affects nearly 16 million Americans and increases their risk of type 2 diabetes in addition to boosting their risk of heart disease.

HHS and panel members recommend that physicians routinely test their patients who are overweight and older than 45 for pre-diabetes. However, overweight patients who are younger than 45 and have one or more risk factors should also be considered for testing. Risk factors include a family history of diabetes, low high-density lipoprotein (HDL) cholesterol, high triglycerides, high blood pressure, a history of gestational diabetes, or a high-risk racial or ethnic background (African American, American Indian, Asian American, Pacific Islander, or Hispanic American/Latino).

The good news is that people who have pre-diabetes can decrease their chances of developing diabetes and heart disease with lifestyle changes. Physicians and health educators should encourage at-risk patients to lose weight, increase physical activity, and eat a healthy diet. Modest weight loss of 10 or 15 pounds can dramatically reduce the risk of diabetes. Specifically, people should aim for 30 minutes of aerobic exercise, such as brisk walking, 5 to 7 days a week, and reduce the fat and calories in their diet. Medications to prevent pre-diabetes were not recommended as an initial treatment, but some people may benefit from them. The panel's recommendations, published in the April 2002 issue of Diabetes Care (25(4):742–749), are based on major studies of ways to prevent type 2 diabetes.

Considering the rates of disability and death in the 17 million Americans with diabetes, preventing future cases is of the utmost importance. The National Diabetes Information Clearinghouse offers a booklet titled Am I at Risk for Type 2 Diabetes? that describes the steps people can take to lower their risk. It also includes a checklist of risk factors and recommendations for testing. The publication is available at diabetes.niddk.nih.gov/dm/pubs/riskfortype2/index.htm, or use the online catalog to order printed copies.

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