August 6, 2012

What Can Be Done for Prediabetes?

Until now, I admit I have gone along with the term prediabetes although I have not liked the term and have called for a change in terms. I feel because of the lack of concern by the medical community and the American Diabetes Association and other organizations, it is time for action and declaring this a condition that needs treatment just like diabetes. Because it has some of the complications of diabetes and risks for others, it is time to just call it diabetes and let medications work to bring it under management.

What brought me to this. Visiting a friend that had a doctors appointment recently. He said that the doctor had said his A1c was 7.2 and that he should watch his food consumption as his sugar was a little high. I had to ask if he would see another doctor? My friend asked why? I told him that I was sorry as I was going to be very blunt, but that the information was telling me that something was wrong. I explained that an A1c reading should have gotten another test – oral glucose tolerance test (OGTT), and if it produced what I thought it would, he had diabetes. My friend said that his family had a history of diabetes on both sides of the family.

We discussed the signs and symptoms and they were there, thirst, frequent urination, and tired feeling. My friend is about 15 pounds above the weight he should be for age, height, and body build. I called my endocrinologist office and asked if they had room for a new patient. After a brief discussion, I put my friend on the phone and they had a longer discussion. He did obtain an appointment for this coming Wednesday, August 8, 2012.

Now he was full of questions. We discussed the OGTT and what he could expect. I said he would have a blood draw, and then he would drink a 75 gram container of glucose and have blood drawn at one and two hours. He would have an A1c done and if his readings were over 200 mg/dl (11.1 mmol/l) at one hour, and his A1c was over 7.0 he would be diagnosed as having diabetes. I said that they would also run a kidney test and maybe several other tests to establish a baseline for the future.

My friend followed me back to my apartment and I loaned him my spare blood glucose meter, a lancing device, lancets, and enough test strips to get him to his appointment.
I then demonstrated how to use the lancet and then load the test strip into the meter and place the test strip to wick up the blood. Since this was about a half hour before he would eat his evening meal, I was surprised by the reading of 247 mg/dl (13.7 mmol/l). I asked him if he had eaten any food since lunch and he said no, he had just finished a coke before seeing me.

I asked him how long his doctor had been telling him his sugar was a little high? He responded about two years. I then asked if he had copies of his lab reports? He said no, he had never been offered them. I explained that he would need to go to the doctors office, make his request in writing for the five years of lab tests, and probably sign a paper and show his driver's license and social security card. Then he would probably wait several weeks to receive them. I explained the reasons for this and that this would help him track his own health. I also explained that they may refer him to the laboratory itself although the doctors office should release them. My friend also said his younger brother and sister should be told. I said when he had results of this tests Wednesday. I said they should also do what you are doing.

About two hours later, he called me and said his sister had just called him that she had been diagnosed with prediabetes, and that he should be tested along with their brother. He asked permission to send his brother and sister my blog site URL and email address and I agreed. I asked if his sister had been started on any medication? He said she told him metformin, and since it was generic it did not cost that much, since her insurance would not cover it for prediabetes.

Too many doctors and far too many patients hear the word prediabetes and think nothing about it. Since the diagnosis is not full-blown diabetes, many doctors and patients just ignore the term and the possible future outcome. Yes, a small percentage of doctors and patients do take this serious, but then cannot find the education to manage the diagnosis and make the right decisions to prevent the onset of diabetes. Then the doctors have no medications other than off-label use which insurance will not cover and thus seldom is a prescription issued.

Current prediabetes range is 100 mg/dl (5.6 mmol/l) to125 mg/dl (6.9 mmol/l). This converts to an A1c reading of 5.7% to 6.4%. Yes, we would all like to have A1c's in this range. This is not the point of this blog. It to galvanize people to insist that the medical community wake up and start treating anyone with a reading in this range as having diabetes. This may be the only way to prevent or lessen the current type 2 diabetes epidemic. Actions by the medical community speak louder than words, and when they start pushing actions, then we will see actions by those with diabetes.

This study demonstrates that actions taken do yield results. By treating early and aggressively, interventions with intensive lifestyle changes or medications (including insulin) do significantly reduce the chances of developing type 2 diabetes in the future. Okay, I can understand you saying this was for prediabetes patients. The fact remains that no medical insurance company will cover medications for prevention, including Medicare. While the study has value, once it ended, no more medications were available until a diagnosis of type 2 diabetes is made. That is the reason for calling for a diagnosis of diabetes at the prediabetes levels.

With the Centers for Disease Control and Prevention (CDC) estimating that about 79 million people having prediabetes, the need for action is here now, and not in the future.

In addition to education for these people, many in the medical community will need education to make them aware of the testing that is needed and that they must diagnose diabetes to get people started on medication. The study needs more dissemination and maybe needs to be repeated, but still should not be ignored as the message is there in black and white and needs action.

Will the American Diabetes Association (ADA) take any action – highly doubtful. Will the American Association of Clinical Endocrinologists (AACE) do anything – more likely, as I have seen actions by some of them already; however, many will still not do what they should. We know that we cannot count on support from the American Medical Association. They have their heads positioned like the ADA where no light can be seen.

More bloggers need to write about this travesty being put on the people with prediabetes (actually I should say diabetes) by the ADA and others.

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