Recommendations for Pre-Diabetes

Diabetes screening in diary
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The American College of Endocrinology recently came out with a statement of recommendations for managing pre-diabetes (PDF). In the title, the question is asked "When Do the Risks of Diabetes Begin?" The question is a crucial one.

The paper starts out by making it clear that the diagnosis of Type 2 diabetes is only one point on a continuum of the body's ability to process sugar, and that pre-diabetics (and in some cases even before the pre-diabetes cutoff) ​is risky.

Some quotes: "Epidemiologic evidence suggests that...complications of diabetes begin early in the progression from normal glucose tolerance to frank diabetes." "It is clear that the risks of high blood glucose levels occur earlier than those at which we currently define as diabetes." "The intermediate state of pre-diabetes is not benign."

Among the problems associated with pre-diabetes are increased risk of heart disease, diabetic retinopathy, and "all-cause mortality". The paper points out that in one study, 8% of people with impaired glucose tolerance in the pre-diabetic range had diabetic retinopathy. I think the paper does a great job of outlining why it is so important to address the process of diabetes, which is going on long before the diagnosis of diabetes.

So, what can be done to treat pre-diabetes? Recommendations in the statement include reducing weight by 5-10%, 30-60 minutes of exercise at least 5 days per week, a low-fat "adequate fiber" diet, and possibly medication for control of blood glucose.

There are target goals for blood pressure and LDL cholesterol as well.

Obviously, I am especially interested in the dietary recommendations. Notice that a low-fat diet is recommended, and then possibly medication for blood glucose control. Believe me, medication is much more likely to be needed if people are on a low-fat (read: high carb) diet!

Why on earth don't they recommend lowering carbohydrates, which turn to sugar in the body and raise blood glucose? As recently pointed out by researchers and physicians, there is abundant evidence that carbohydrate reduction is effective in improving many of the problems associated with Type 2 diabetes. Note also a study in a recent Archives of Internal Medicine which showed no protection from diabetes from eating a low-fat diet.

The other thing that is missing from the recommendations, in my opinion, is advising home monitoring of blood glucose for pre-diabetics. As a pre-diabetic myself, blood glucose monitoring is a great way to understand how different foods affect my blood sugar, and it keeps me motivated to eat and exercise in a way to keep my blood sugar as close to normal as I can get it. If an organization such as the American College of Endocrinology started recommending this, perhaps more insurance companies would consider covering the costs of monitors and test strips.

Photo © Richard Cano

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