HCN News & Notes

Awareness, Education Are Key to Avoiding Prediabetes

SPRINGFIELD — There is good news and bad news when it comes to type 2 diabetes.

The good news is that the rate of new cases of diabetes — about 95{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of those diagnosed have type 2 diabetes — has decreased among U.S. adults. Also, newer drugs, easier glucose monitoring, and a gain in understanding among patients how diet and exercise impacts their diabetes is resulting in better outcomes.

“New non-insulin medications have been paramount to improving diabetes management and have also had significant impact on weight, as most of these medications not only improve blood sugars, but also curtail appetite,” said Dr. Chelsea Gordner, an adult and pediatric endocrinologist at Baystate Medical Center and Baystate Children’s Hospital. She noted that these newer medications include injectable GLP1 agonists, oral SGLT2 inhibitors, and oral DPPIV inhibitors.

“We also have newer ways to monitor blood sugar which do not require pricking the finger for a blood sample. In addition to medication, eating a healthy diet and exercising 30 minutes per day is recommended to help control the diabetes and reduce long-term complications,” she added.

The bad news is that there are still more than 100 million U.S. adults who have diabetes or prediabetes (a condition in which blood-glucose levels are higher than normal, but not yet high enough to be diagnosed with diabetes). Nearly nine out of 10 people with prediabetes do not know they have it, and the only way to find out is to have a doctor order a blood test.

Risk factors for prediabetes include age (45 or older), being overweight, lack of physical activity, high blood pressure, high cholesterol, women who had gestational diabetes and/or giving birth to a baby weighing over 9 pounds, and a family history of diabetes. African-Americans and Hispanics are more at risk for the disease.

“The good news is that committing to lifestyle changes, such as eating healthier and exercising, which will help you to lose weight and hopefully lower your cholesterol and blood pressure, too, can halve your risk of developing prediabetes,” Gordner said.

If not treated within five years, prediabetes can lead to type 2 diabetes. Diabetes occurs when the body does not produce or properly use insulin, which is a hormone that aids in the conversion of sugar, starches, and other foods into energy that is needed for daily life. Those with type 2 diabetes have insulin being produced in their body, but cannot use it effectively and are in a state of insulin resistance, requiring medications and/or insulin injections.

If left untreated or not managed properly, people with diabetes put themselves in harm’s way for serious complications, such as heart disease, stroke, blindness, kidney damage, and limb amputations.

Symptoms of diabetes include frequent urination, unusual thirst, extreme hunger, unusual weight loss, and extreme fatigue and irritability. Also, those with type 2 diabetes may have frequent infections, blurred vision, cuts and bruises that are slow to heal, tingling/numbness in the hands or feet, and recurring skin, gum, or bladder infections.

The continued bad news is that the rates of new cases of diabetes among children and adolescents has increased as rates of overweight and obesity have increased in all age groups among children 2-19, according to a study published in the March 2018 issue of Pediatrics.

“There is clearly a link between obese youngsters and developing type 2 diabetes in childhood and adolescence, a condition we once referred to as adult-onset diabetes because it was diagnosed primarily in adults, said pediatric endocrinologist Dr. Rushika Conroy of Baystate Children’s Hospital. “To complicate matters, treatment options for children are fewer than what is available for adults, and they are more likely to not respond as well to oral medication alone.”

She noted that up to 50{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of children and adolescents treating their diabetes with oral medication and dietary modification ended up needing insulin within two years of diabetes onset, according to a trial in pediatric patients with type 2 diabetes.

“Even more concerning is the fact that these youngsters are developing diseases that can develop from years of poorly controlled type 2 diabetes in a shorter amount of time than we see with adults, suggesting that this may be the first generation of children who do not outlive their parents,” Conroy said.

She noted that prevention of type 2 diabetes in youth is no different than it is for adults — involving lifestyle modifications such as increasing daily activity; reducing the intake of calorically dense, nutrient-poor foods; and increasing the consumption of nutrient-rich foods. The good news is that, compared to adults with prediabetes, resolution of prediabetes to a normal level of glucose in the blood is higher in pediatric patients through dietary modification.

“So, if we can strenuously implement dietary changes for adolescents and children with prediabetes,” Conroy added, “we will see a great impact on their overall health and well-being.”

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