University of Virginia Health System

Healthy Lifestyle Can Keep Pre-Diabetes under Control

Experts say 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.

"Diabetes has become the major problem in the United States," says Dr. Harold Lebovitz of the State University of New York Health Sciences Center at Brooklyn.

Lebovitz notes 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?" says Lebovitz. "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 U.S. will continue to cost more, unless something is done to stop it, notes Lebovitz.

"Diabetes starts at an earlier stage, called pre-diabetes," he says. "The question arises, should you wait for pre-diabetic patients to develop diabetes and the complications, or should you take a preventive approach?"

First Push: Exercise and Healthy Diet

The American Association of Clinical Endocrinologists (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.

UVA's Saunders says lifestyle changes can have a tremendous impact, pointing to results from the Diabetes Prevention Program, a large national diabetes prevention study involving more than 3,000 people. The study, Saunders says, demonstrated convincingly that the onset of diabetes can be significantly delayed among people with pre-diabetes through the adoption of healthier patterns of eating and physical activity. Participants in the study's lifestyle intervention group showed a 58 percent reduction in the development of diabetes over about 4 years compared with a control group.

Weight loss was the most powerful factor in reducing the development of diabetes, regardless of age, gender or race.

"Interestingly, we are not talking about needing to lose major amounts of weight to make a difference," Saunders says.

The study's authors estimated that losing about 11 pounds reduced the risk of developing diabetes by 55 percent over about 3 years.

At the end of one year, those in the lifestyle intervention group lost an average of about 15 pounds by reducing their fat intake by about 7 percent and engaging in moderate exercise (mainly walking) five days a week for about 30 minutes.

But even modest changes like these are difficult for most people to achieve without help, Saunders notes. "Lifestyle education and support is essential," he says. "Crash diets and sudden increases in physical activity are generally short-lived and potentially do more harm than good. Small changes over time are the order of the day."

"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," adds Lebovitz.

Many people question whether pre-diabetes is actually a disease, notes Lebovitz.

"The important message is that pre-diabetes is not something people don't have problems with," he says. "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."

Cynthia Moore, M.S., R.D., CDE, a certified diabetes educator and Assistant Clinical Nutrition Manager for the University of Virginia Health System, has some tips to help pre-diabetes patients manage their health issue and prevent their disease from becoming full-blown diabetes.

Suggested dietary changes from Moore include:

• Eat on a regular schedule, spacing meals or snacks three to five hours apart. Three smaller meals are better than two big meals.
• Learn to read food labels for carbohydrate, fiber and fat content. Women should eat about 30-45 grams carbohydrate per meal, while men should eat about 45 to 60 grams of carbohydrates per meal.
• Eliminate or cut down on high-carbohydrate beverages such as soda, juice and sweetened tea.
• Eat more vegetables. At each meal, make half your plate vegetables.
• Lose weight. Weight loss of 5 to 20 pounds is very helpful but requires eating, exercising and stress management changes.
• Keeping a daily journal of your food and exercise can help track changes.

Moore also suggests some lifestyle changes, including:

• Exercise at least every other day. Exercise cuts down on insulin resistance, so it gets at the root of the problem of pre-diabetes and type 2 diabetes 2 by helping cells use glucose. Walking, swimming or strength training are excellent choices. The exercise you can get through daily living, such as taking the stairs instead of an elevator, also qualify as helpful.
• Get at least seven hours of good-quality sleep most nights. Insufficient sleep (less than six hours of sleep or poor sleep quality) changes hormones like leptin, grehlin and cortisol that influence appetite and contribute to weight gain. Get tested for sleep apnea if you snore or have daytime sleepiness.
• Manage your stress level. Stress raises blood glucose, and can contribute to stress eating. Getting trained in a system like Mindfulness Based Stress Reduction or DST/Solution Training can help with stress reduction.
• People with depression should seek treatment.

Second Push: Control Heart Problems

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

Because there are no medication therapies approved by the U.S. Food and Drug Administration (FDA) 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, people who cannot modify their cardiovascular risk by lifestyle changes need to be treated for high blood pressure and high cholesterol and should receive 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," says Dr. Daniel Einhorn, vice president of AACE. "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."

To learn more about treating and managing diabetes - or to find a diabetes specialist - visit www.uvahealth.com.

Always consult your physician for more information.