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'Pre-Diabetes' Tests Urged for Overweight Americans

By Susan Okie
Washington Post Staff Writer
Thursday, March 28, 2002; Page A08

The government yesterday for the first time urged overweight Americans to get tested for a newly defined condition called "pre-diabetes" as part of a campaign to stem a growing epidemic of diabetes in the United States.

The recommendation was prompted by the recent recognition that people who are at risk of developing diabetes can be identified and their risk of going on to develop the full-blown disease can be cut substantially by weight loss and exercise.

^___ Reducing Risk ^___

People with "pre-diabetes"—blood glucose levels that are above normal but not yet high enough to be classified as diabetes—can often prevent or delay diabetes if the lose weight and exercise.

Who should be tested

• People over 44 and overweight (Body Mass Index of 25 or higher). Testing strongly recommended.

• People over 44 who are not overweight and have no other risk factors. Consult doctor about testing.

• People 44 or younger who are overwight and who have at least one additional risk factor (see list below). Consult doctor about testing.

Risk factors

1. Being overweight.

2. Having a parent, brother or sister with diabetes.

3. Having a family background that is African American, American Indian, Asian American, Hispanic/Latino or Pacific Islander.

4. Having had diabetes during pregnancy or having given birth to a baby weighing 9 pounds or more.

5. High blood pressure (or blood pressure of 140/90 or higher).

6. HDL ("good") cholesterol of 35 or lower, or triglyceride level of 250 or higher.

"Diabetes has reached epidemic proportions and it's still on the rise," Health and Human Services Secretary Tommy G. Thompson said at a briefing yesterday. "What gives us hope . . . is that people with pre-diabetes can take meaningful steps now to reduce their risks and avoid having diabetes."

The rising incidence of diabetes in the United States is the result of a dramatic increase in obesity, as well as the aging of the population. The latest figures show that in addition to the estimated 17 million Americans who have full-blown diabetes, at least an additional 16 million have "pre-diabetes," Thompson said.

People with pre-diabetes have levels of glucose (a sugar in the bloodstream) that are higher than normal but not high enough to be classified as diabetes. It causes no symptoms, but without treatment most people with the condition go on to develop diabetes, which is the sixth leading cause of death in the United States and a major contributing cause of heart disease, stroke, kidney failure, high blood pressure and blindness.

A new campaign, sponsored by HHS and the American Diabetes Association (ADA), seeks to inform the public and health care professionals about the need to identify and treat pre-diabetes.

"Some people have . . . become fatalistic, believing diabetes is inescapable," said Judith Fradkin of the National Institutes of Health. "Those are the people we most need to reach with this message that diabetes can be stopped."

Thompson said HHS will also try to persuade health insurers and employers to pay for testing and treatment to prevent diabetes, a disease that is estimated to cost the U.S. economy $100 billion annually. Except for certain screening tests mandated by Congress, the federal Medicare program does not pay for preventive treatment.

According to the new recommendations, pre-diabetes can be diagnosed by either of two blood tests. A fasting plasma glucose (FPG) test measures the level of glucose in the bloodstream after an overnight fast. A two-hour oral glucose tolerance test (OGTT) includes the FPG test and measures the glucose level two hours after the person being tested drinks a solution containing glucose.

The guidelines state that testing is strongly recommended for anyone who is 44 or older and overweight (defined as a Body Mass Index of 25 or higher). They say doctors should also consider testing people older than 44 who have no risk factors, as well as younger adults who are overweight and who have at least one other risk factor for diabetes.

If the test for pre-diabetes is normal, it should be repeated every three years, according to the recommendations. If pre-diabetes is diagnosed, the patient should receive counseling on weight loss and increasing exercise and should be monitored every year or two for possible diabetes.

In two large studies -- in Finland and in the United States -- overweight people with pre-diabetes who lost moderate amounts of weight and exercised regularly reduced their risk of developing diabetes by 58 percent, compared with people with the condition who did not make those lifestyle changes. Drugs used to treat diabetes are not recommended for pre-diabetes because studies so far suggest they are less effective than weight loss and exercise.

"Just 30 minutes of walking a day, five days a week, can significantly reduce the risk of developing diabetes," Thompson said.

In the Finnish study, the goal was to have participants lose 5 percent of their body weight and exercise moderately for 150 minutes each week. In the U.S. study, the exercise goal was the same but the weight loss goal was 7 percent of body weight.

Participants in both studies received considerable incentives, such as nutritional counseling, exercise classes, meal plans and sometimes gifts such as exercise equipment or gym memberships. Even so, in the U.S. study only 50 percent reached the weight loss goal and in the Finnish study, only 43 percent. Seventy-four percent of participants in the U.S. study and 36 percent in the Finnish study reached their exercise goal.

Thompson and other speakers at the briefing acknowledged that such lifestyle changes are difficult for many people. Thompson promised to recruit actors and athletes to help in the campaign against diabetes and to send the administration's new surgeon general, Richard H. Carmona, "out on the road" if his appointment is confirmed.