After a routine test of her blood sugar eight years ago, Randi Sue Baker, a seriously overweight 64-year-old, learned that Type 2 diabetes was bearing down.
With that test result, she joined the 79 million Americans over the age of 20 who have prediabetes. Up to 70 percent of them will go on to develop diabetes, but 90 percent don’t even know they are at risk. In fact, as many as 28 percent of adults with full-blown diabetes don’t know they have it, according to Edward W. Gregg, a senior epidemiologist at the Centers for Disease Control and Prevention.
Ms. Baker, who lives in Brooklyn, considers herself lucky to have been forewarned. She realized that while she was still relatively healthy, she could make a concerted effort to stay that way.
For the last several years she has kept track of her caloric intake, the kinds and amounts of the carbohydrates she eats, and the overall healthfulness of her diet. She exercises five days a week, walking for 30 minutes and then swimming for an hour at the local Y. She is down 50 pounds from her top weight.
Ms. Baker also daily monitors her blood sugar, or glucose, level and takes a drug called metformin to help keep it within a normal range. Periodically, her doctor checks her blood level of hemoglobin A1C, another indicator of diabetes, to be sure it hasn’t risen.
Could Ms. Baker do more? If she were willing to undergo bariatric surgery, perhaps. The operation has risks but has been shown to “cure” diabetes in about a third of patients.
But what Ms. Baker already is doing to keep diabetes at bay is far more than most people who are likely to develop it do.
Diabetes is now an out-of-control epidemic responsible for a devastating toll in health, lives and medical care costs. In 2012 the condition accounted for $245 billion in health care expenses, about one in five health care dollars.
Among its serious complications are heart disease, stroke, kidney damage, nerve damage, eye disease (which can lead to blindness), foot damage (which can lead to amputations) and hearing loss.
Diabetes is the No. 1 cause of blindness, kidney failure and amputations, Dr. Elizabeth Seaquist, an endocrinologist and diabetes expert at the University of Minnesota, said in an interview. The condition even has been linked to dementia, including Alzheimer’s disease.
The two primary causes of Type 2 diabetes — obesity and inactivity — have thus far resisted countless efforts to reverse or prevent them. National data from 2000 to 2011 show that about 40 percent of adults face a lifetime risk of developing diabetes, an increase of up to 20 percent since the late 1980s, Dr. Gregg and his colleagues recently reported.
If this tsunami continues to roll forward, experts predict that by 2050 the number of adults with diabetes will reach one in three.
The risk of developing diabetes rises with age. Currently about one in four Americans ages 65 and older has diabetes, and the number will grow as the population ages.
In theory, it is possible to avert the impending health crisis. Because complications typically take 20 years to become apparent, identifying people at risk of diabetes early and taking corrective action could delay onset of the disease and its devastating consequences, perhaps for the rest of their lives.
The American Diabetes Association has created a simple seven-question test to help people assess their risk; a paper copy can be found at www.diabetes.org. Important factors include a family history of the disease, prior gestational diabetes, being overweight or obese, physical inactivity and older age.
A dozen years ago in its journal, Diabetes Care, the association noted “growing evidence that at glucose levels above normal but below the threshold diagnostic for diabetes, there is a substantially increased risk of cardiovascular disease and death.”
A person with prediabetes has a blood glucose level higher than normal but not yet in the range of diabetes. While not everyone with the condition will progress to full-blown diabetes, over time, prediabetes can cause much the same underlying damage to body tissues and organs.
The trouble starts even before glucose levels begin rising, when the body becomes resistant to the effects of insulin, the pancreatic hormone that regulates how much glucose circulates freely in blood.
Insulin’s main job is to move glucose from the blood into cells to be used for energy or stored for future needs. Insulin resistance, the portend of prediabetes, prompts the beta cells of the pancreas to produce more and more of this hormone to keep blood glucose levels normal.
Gradually, pancreatic cells wear out, setting the stage for rising blood glucose, prediabetes and diabetes.
The risk of developing diabetes is highest among African-Americans, Hispanics and Native Americans, but no ethnic or racial group is spared.
While excess weight is the leading risk factor, even people of normal weight can develop the disease if they carry too much fat in their abdomen. So-called central obesity may explain why the Japanese and others of Asian descent often develop diabetes at weights well below the range of obesity, Dr. Seaquist said.
She called prediabetes “a wake-up call” and emphasized that “modest weight loss can help. You don’t have to lose 100 pounds to prevent diabetes.” A loss of 7 percent to 10 percent of body weight can be effective.
Nor do you have to become an exercise fanatic. “Moderate activity, 30 minutes a day five or more days a week, is helpful and can even be broken up into 10-minute segments,” Dr. Seaquist said. “More is better, but it’s a place to start.”
She also offered advice for Americans in general: “Probably we all should consider ourselves at risk. We eat too much, more than we need, and that’s not healthy even if we don’t get diabetes.”
“We should be avoiding drinks that are high in calories,” she added. “They make it too hard to regulate food intake. Drinking water is safest all around — it’s natural and organic.”