Prediabetes

In my practice, I spend a lot of time discussing the same subjects, giving the same advice, and relaying the same information to patients who sometimes seem interested in what I have to say and other times who seem quite disengaged with the conversation regarding their health. I utilize a variety of methods to impart important messages: motivational interviewing, scared-straight tactics, and familial pressure-I invite the spouse or significant other to come to the visits.  

Ok, I know you are thinking why would a doctor resort to using information to evoke fear? But in my defense, every bit of knowledge I share can be found in reputable journals, online, and from other healthcare professionals. The only difference in the techniques used above is the tangible examples I add. I am a firm believer that patients need a visual picture to understand the gravity of certain diseases. Telling someone that diabetes can cause microvascular disease is evidence based and should be included in routine care. However, showing a picture of diabetic foot ulcers or describing how those ulcerations progress to below the knee amputations is a lot more powerful! 

Recently, researchers have shown more people than previously reported are pre-diabetic and are unaware of their diagnosis. Hemoglobin A1C (HbA1c) is a diabetic marker that gives an average of blood sugars over the last few months. Individuals without diabetes or prediabetes should have a reading less than 5.7 percent, which indicates normal blood sugars. Readings greater than or equal to 5.7 percent and less than 6.5 percent are considered to be in the pre-diabetic range.  

I like to think of the HbA1C marker as a diagnostic tool similar to the ones used by mechanics.  If the mechanic noticed a problem with the tires on your vehicle, who in their right mind would ignore his warnings and continue to drive on those faulty tires? Would you actually gamble with such a risky situation? I seriously doubt it, because you can picture in your head the potential result. This is what I try to do in the outpatient setting as well. I try to provide a vivid mental collage of the consequences of ignoring the warning signs of diabetes.  

In the last 30 years, the number of Americans with diabetes has more than tripled, 5.6 million people in 1980 compared to 20.9 million people in 2011. Approximately 8 million people are undiagnosed!  Many of you reading this column are probably undiagnosed pre-diabetics.  Hispanics, blacks and American Indians share the greatest burden of diabetic disease.  

In 2011, the primary cause of kidney failure in 44 percent of the new cases was diabetes.  Blindness, strokes, heart attacks are all possible sequelae of diabetes. Furthermore, the cost of treatment, time spent at doctor’s visits, loss of job productivity, and the other potential health problems are all additional concerns piled upon the diabetes burden. 

This is why prevention is crucial to this conversation. My mantra is and always will be: “preventing disease is cheaper than treating it.” Therefore, heed the warning signs. Excess weight is a major risk factor for diabetes. Looking good in a bathing suit and being in the best shape as compared to your former high school classmates are not the only reasons for maintaining a healthy weight. Although those goals are good reasons, they should not be number one on the list. The initial priority is appropriate height/weight ratios which then help reduce the likelihood of developing type 2 diabetes.  

Being diagnosed with prediabetes is merely an alert switch in your body. Once that knowledge is obtained, it is up to you to determine your life’s course. I have countless examples of people who have been on both sides of the fence when it comes to preventative care. I’ve had patients who when diagnosed with prediabetes, immediately made some lifestyle modifications and thereby halted diabetes progression. They started exercising, met with the diabetic educator, and changed their eating habits. Others on the other hand, chose to delay making those changes and progressed to full blown diabetes. 

The choice is yours. Get tested for prediabetes today. Testing is a simple finger stick or blood draw. Call your doctor and begin the awesome adventure to wellness!

Yours in Service,

Denise Hooks-Anderson, M.D.

Assistant Professor

SLUCare Family Medicine

yourhealthmatters@stlamerican.com