Twofold Action Urged for Pre-Diabetes

WEDNESDAY July 23, 2008 -- Lifestyle changes, coupled with a reduction in heart disease risks, will go a long way toward preventing pre-diabetes from progressing to the full-blown disease, experts from the American Association of Clinical Endocrinologists (AACE) recommend.

Pre-diabetes occurs when blood sugar levels or impaired glucose tolerance is elevated, but not quite to the point defined as diabetes. More than 56 million Americans currently suffer from pre-diabetes, according to the U.S. Centers for Disease Control and Prevention.

"Diabetes has become the major problem in the United States," Dr. Harold Lebovitz, a professor of medicine at the division of endocrinology and metabolism/diabetes at the State University of New York Health Sciences Center at Brooklyn, said during a noon teleconference Wednesday.

Lebovitz noted that diabetes is the main cause of kidney failure and most blindness in adults, and causes about 60 percent of cardiovascular diseases.

"The issue is, do you wait until patients really develop these catastrophic complications?" Lebovitz said. "Last year, it cost $170 billion in direct and indirect costs to take care of people with diabetes."

The growing epidemic of diabetes in the United States will continue to cost more, unless something is done to halt it, Lebovitz noted. "Diabetes starts at an earlier stage, called pre-diabetes," he said. "The question arises, should you wait for pre-diabetic patients to develop diabetes and the complications, or should you take a preventive approach?"

The AACE is pressing for aggressive action to keep pre-diabetes from progressing to full-blown diabetes. The first step involves lifestyle changes, such as diet and exercise. "It will cost a lot of money to develop lifestyle programs, but in the long run we will save trillions of dollars in health care," Lebovitz said.

Many people question whether pre-diabetes is actually disease, Lebovitz said. "The important message is that pre-diabetes is not something people don't have problems with," Lebovitz said. "Sure, they don't have any problems when they're 30, but when they're 50, they've had their heart attack and now they have an ulcer on the foot."

In addition to lifestyle changes, the AACE thinks that pre-diabetes needs to be treated more aggressively.

Since there are no drug therapies approved by the U.S. Food and Drug Administration for treating pre-diabetes, the AACE suggests another way to get them: Reduce the number at which blood sugar levels define diabetes. That would make current medications available to people who are now classified as pre-diabetic.

In addition, those who cannot modify their cardiovascular risk by lifestyle changes need to be treated for high blood pressure, high cholesterol, and should have medications to control blood sugar levels.

"The data show that there is a spectrum of severity, with the most severely affected approaching the risks of people with diagnosed type 2 diabetes," Dr. Daniel Einhorn, vice president of the AACE, said in a statement. "In these highest-risk individuals, who represent a minority, pharmacologic strategies may be appropriate if intensive lifestyle therapies fail. Regardless, all individuals at risk for diabetes should be aware of the level of their risk factors and be prepared to take action."

Posted: July 2008


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