US Pharm. 2021;46(11):15-16.

Higher Heart Attack & Stroke Risk

Every year, 1.5 million adults in the United States are diagnosed with type 2 diabetes (T2D)—a condition in which the levels of glucose in the blood are abnormally high. T2D is a progressive condition, meaning it develops slowly over a long period. In 1997, the American Diabetes Association formally recognized a state called prediabetes, wherein blood sugar levels are higher than normal but not high enough to be defined as diabetes. Studies have shown that without intervention, individuals with prediabetes are likely to develop diabetes within the next 10 years. In addition, those with prediabetes are at a significantly higher risk of heart attack and stroke, even before they become diabetic.

A Warning Signal

Insulin is a hormone made by your body that helps blood sugar to enter into the cells for use as energy. For those with prediabetes, the cells in the body cannot respond normally to insulin. As a result, the pancreas makes more insulin to try to get cells to respond. Eventually, the pancreas cannot keep up and blood sugar rises, setting the stage for prediabetes—and eventually T2D.

Prediabetes and diabetes are two points on a decades-long journey from normal glucose control to limited or absent control of blood sugar. Several risk factors, the same ones that lead to diabetes, can progress to prediabetes. Being overweight is the strongest risk factor, but others include a history of gestational diabetes, having an immediate relative with T2D, and being over the age of 45 years. The prevalence of prediabetes is also higher among American Indian/Alaska Native (14.7%), Asian (9.2%), Hispanic/Latino (12.5%), and non-Hispanic Black (11.7%) people.

Early Screening and Intervention Are Important

Because obvious physical symptoms may not be present, most people are not aware they have prediabetes. Regular blood screening is recommended for overweight or obese individuals starting at age 35 years and for all others over age 45 years, regardless of risk factors. It is currently recommended that individuals who meet the above criteria be screened once every 3 years. During screening, doctors will look for blood glucose levels higher than normal but not high enough for a diagnosis of T2D.

Prediabetes and T2D screening tests measure fasting plasma glucose (FPG) or HbA1c levels in the blood, while an oral glucose-tolerance test measures how well an individual handles sugar after drinking a glucose solution. An FPG level of 126 mg/dL or greater, an HbA1c level of 6.5% or greater, or a 2-hour glucose level of 200 mg/dL or greater is consistent with the diagnosis of T2D. A fasting plasma glucose level of 100 to 125 mg/dL, an HbA1c level of 5.7% to 6.4%, or a 2-hour glucose level of 140 to 199 mg/dL is consistent with prediabetes.

Can Be Reversed Before Advancing to T2D

Lifestyle modifications are the first and most effective methods of reversing prediabetes and avoiding progression to T2D. Some studies have shown weight loss and increased physical activity can even overcome genetic risk factors for T2D. Losing just a modest amount of weight, or 5% to 7% of body weight (10-14 pounds for a 200-pound person), is effective at reducing the risk of T2D development. Adding regular physical activity to improved diet further reduces risk by improving overall health. Regular physical activity means getting at least 150 minutes a week of brisk walking or similar activity, or just 30 minutes a day, 5 days a week.

Though invasive, expensive, and not without side effects, weight-loss surgery has been proven effective at reducing weight, controlling blood sugar, and preventing or delaying diabetes in those with prediabetes. The current recommendation for weight-loss surgery from the National Institutes of Health is for those with a BMI of 35 or higher who have prediabetes and for whom lifestyle modifications have not been successful.

Some studies suggest that use of the drug metformin in those with prediabetes is effective at lowering blood glucose and delaying or preventing diabetes; however, these drugs are not currently approved by the FDA for prediabetes treatment.

The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.

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