Borderline Diabetes

Approximately 800,000 Americans will be told they are diabetic. They will join the 16 million Americans who already suffer from the disease. These diabetes patients risk debilitating complications such as blindness, kidney disease and lower-extremity amputations.

Now, physicians are identifying a category of people at risk for diabetes. These people have impaired glucose tolerance (a blood sugar level between 140 mg/dl and 199 mg/dl two hours after ingestion of a glucose solution) and are sometimes referred to as borderline diabetics.

Once these at-risk people are identified, the real issue is how to prevent their borderline diabetes from progressing to full-fledged diabetes. The National Institutes of Health is sponsoring a national Diabetes Prevention Program to determine whether type 2 (adult onset) diabetes can be prevented through diet and exercise or medication. The Diabetes Prevention Program involves 26 prestigious hospitals across the country. Many of these hospitals participated in the national study to prevent long-term complications in type 1 diabetics.

Northwestern University Hospital was a leading participant in the study upon which treatment of type 1 diabetes is based. Now, Northwestern has turned its attention to prevention of type 2 diabetes through the Diabetes Prevention Program.

Experts at Northwestern agree with those throughout the country on at least one point: weight loss and exercise can be critical in the prevention of diabetes. Almost 60 percent of persons with type 2 diabetes are overweight. There are approximately 16 million persons with diabetes in the U.S., and about 90 percent of these are type 2. Thus, roughly six to eight million persons may have type 2 diabetes as a consequence of being overweight.

It is not clear how much weight needs to be lost to reduce the risk for diabetes. The program coordinator of the Diabetes Prevention Program says, “Even five pounds may make a difference. We had a patient who lost 10 pounds. Losing those 10 pounds resulted in lower blood pressure, which meant that no medication was necessary.”

While weight loss is important, physical activity is also critical for people suffering from diabetes. Of course, losing weight and exercising are difficult for those who are out of shape and out of the habit. However, experts believe it is important to see the diagnosis of impaired glucose tolerance as an opportunity to modify your lifestyle and avoid the serious complications of diabetes. The main reason not to wait is that irreparable damage can be done to your eyes, kidneys and lower extremity circulation before you are diagnosed with diabetes. In addition, maintaining a healthy weight and being physically active will also lower your risk of heart disease, some cancers, osteoarthritis, back pain and sleep apnea, as well as improve your mobility, flexibility and overall quality of life.

The Diabetes Prevention Program is also testing the ability of metformin to prevent the progression of borderline diabetes into type 2 diabetes. While the study will answer important questions about the role of lifestyle changes and medication in preventing diabetes, doctors believe that drugs are less effective in the absence of exercise and diet modification.