| |
Pre-diabetes and Primary Prevention
An estimated 54 million Americans aged 40 to 74 years (40.1% of the U.S. population in this age group) have pre-diabetes, a condition that puts them at high risk for developing type 2 diabetes. Without intervention, people with pre-diabetes will progress to type 2 diabetes at a rate of 10% per year. Pre-diabetes also increases the risk of heart disease and stroke (3).
Pre-diabetes is a condition in which blood glucose levels are higher than normal but not in the diabetes range. Pre-diabetes is defined as impaired fasting glucose (IFG) of 100 to 125 mg/dl or impaired glucose tolerance (IGT) diagnosed by a post 75-gram glucose challenge (oral glucose tolerance test or OGTT) of >140 to <200 mg/dl or both IFG and IGT. (See appendix B for more information on blood glucose testing.) The Am I at Risk for Type 2 Diabetes? brochure, produced by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), can help patients and providers assess individual risk for Pre-diabetes.
Primary Prevention
Primary prevention refers to preventing diabetes from occurring. Secondary prevention refers to preventing complications in those who already have diabetes (e.g., prevention of neuropathy) and tertiary prevention refers to prevention of worsening complications (e.g., amputation resulting from injury to a neuropathic foot) or death.
The burden of diabetes is high. On average, more than 4,100 people are diagnosed with diabetes every day. On average, 55 go blind, 120 experience kidney failure, and 230 have a limb amputated every day. The rate of prevalence increase is high. In the past 25 years, the number of Americans with diabetes has more than tripled (from 5.8 million to 20.8 million), and future projections are high.
It is estimated that of persons born in America in 2002, 1 in 3 will develop diabetes in his or her lifetime. For Hispanic/Latino women, the statistic is 1 in 2…unless something changes.
Trend is not Destiny
Type 2 diabetes can be prevented or delayed. A major clinical trial—the Diabetes Prevention Program (DPP) study—provided scientific evidence that the onset of diabetes could be prevented or delayed in people at high risk. In the DPP, adults with Pre-diabetes reduced their risk of developing diabetes during the course of the study by 58% through such lifestyle changes as:
- Reduced fat and calorie intake.
- Increased physical activity of at least 150 minutes/week (e.g., brisk walking 30 minutes a day, 5 days/week).
- Loss of more than 5% to 7% of body weight.
Table 6.
| FPG* |
100–125 mg/dL |
IFG (pre-diabetes) |
| FPG |
>125 mg/dL |
Diabetes |
| OGTT** |
2-hour value 140–199 mg/dL |
IGT (pre-diabetes) |
| OGTT |
2-hour value >200mg/dL |
Diabetes |
These lifestyle changes were effective in preventing or delaying diabetes in all ages and all ethnic groups in the DPP. Among people aged 60 years and older, progression to type 2 diabetes was reduced by 71%. The DPP showed that moderate changes resulting in modest weight loss can make a difference (9).
DPP participants have been enrolled in a continuation study and follow-up
data will be forthcoming. Further information on pre-diabetes, testing recommendations, and information on the NDEP’s Small Steps. Big Rewards. Prevent Type 2 Diabetes. campaign and tools can be found on the NDEP Web site at ndep.nih.gov/campaigns/SmallSteps/SmallSteps_index.htm.
The Role of PPOD Providers in Primary Prevention
All health care providers can play a role in diabetes primary prevention and diabetes control. As a pharmacist, podiatrist, optometrist, dentist, or dental hygienist, you can make a difference in primary prevention:
- You know your patients.
- Your patients trust you.
- A few words from you can go a long way.
- You can determine with just a few questions who is at high risk for diabetes (see risk factor list below).
Do Your Patients Have any of the Following Risk Factors?
- Family history of type 2 diabetes.
- Overweight or obesity.
- High blood pressure or cholesterol.
- African American, American Indian/Alaska Native, Asian American, Hispanic/Latino, Native Hawaiian/Pacific Islander ethnicity.
- Pre-diabetes.
- Age of more than 45 years.
- History of gestational diabetes (GDM).
Gestational Diabetes Mellitus (GDM)
It is estimated that women who have had GDM have a 20% to 50% likelihood of developing type 2 diabetes in the 5 to 10 years following pregnancy. Without intervention, progression from Pre-diabetes to type 2 diabetes occurs at a rate of approximately 10% per year. With NDEP resources and self-management support for behavior change, diabetes can be prevented
or delayed.
Always advise patients to check with their primary care provider before beginning an exercise or physical activity program.
A Few Words Can Go a Long Way
You don’t need to do it all—resources are available to help. Your patients will appreciate that you care about their overall health
Ask: “Has anyone ever told you that you are at risk for diabetes?”
Advise: “You can take action to prevent or delay type 2 diabetes.”
Assist: Give your patients resources to help them make healthy changes:
- Refer to a primary care provider.
- Use the free primary prevention materials available from the National
Diabetes Education Program (NDEP)—call 1-800-438-5383, visit www.ndep.nih.gov or use the order form in the Appendix.
Primary Prevention Hypothetical Cases
-
A 30-year-old woman at a routine dental hygienist appointment shares that fact that she recently delivered a nine-pound baby after a pregnancy complicated by GDM. She exclaims “Thank goodness that’s all over!”
The dental hygienist tells her of the high lifelong risk of developing type 2 diabetes in women who have had GDM. The patient learns about the free NDEP materials available to help her lose weight and prevent or delay the onset of type 2 diabetes.
-
A 45-year-old African American woman brings her mother in for her annual comprehensive diabetes eye exam. The eye care provider asks if she ever considered that she, too, might be at risk for developing diabetes. The woman is surprised. “Me? I just never thought much about it. I’ve always been focused on Mama.” The eye care provider gives the woman the Am I At Risk? brochure, NDEP’s toll-free number and Web site URL, and suggests she make a follow-up appointment with her own primary care provider.
-
A 50-year-old man accompanied by his overweight teenage son asks the pharmacist about weight loss pills. The pharmacist asks to talk to both father and son together. The teen seems embarrassed and unconvinced. He says “What am I supposed to eat when the guys are all eating cheeseburgers and fries after school?!” The pharmacist agrees that changing eating habits is hard, but not impossible. Smaller portions, or choosing a plain hamburger instead of the oversized one with cheese, can make a difference. He suggests the family take a look at NDEP’s Web site for tip sheets on healthy eating and physical activity, and that they talk to a dietitian. Dad agrees to play basketball with his son a couple of nights a week—good exercise for both of them.
-
A 70-year-old man consults a podiatrist because of painful corns on his feet. He says “I don’t walk anymore because of these corns, but I guess that doesn’t matter—I’m too old to be walking much now.” The podiatrist emphasizes the many benefits of regular physical activity such as walking, including diabetes prevention. He explains that 1 in 5 people over age 60 have diabetes, but that the disease can be prevented or delayed. He shares the NDEP “It’s Not Too Late to Prevent Diabetes” tip sheet with the man and points out NDEP’s toll-free number and URL. He says, “After we get these corns fixed up, I want to see you out there walking!”
May 2007 |
|
