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About 20 percent of the population of the United States has "prediabetes," according to the American Diabetes Association. That means some 61.7 million people are overweight, underactive and have higher-than-normal blood-glucose levels, putting them at risk for developing adult-onset or type 2 diabetes.

Type 2 diabetes, a metabolic disorder in which a person's body still produces insulin but is unable to use it effectively, is usually diagnosed in adulthood and does not always require insulin injections. (Type 1 diabetes -- an autoimmune disease -- is a separate and different illness.)

The increasing occurrence of type 2 diabetes -- particularly among children -- is dramatic, alarming and should serve as a wake-up call to a nation already reeling from an epidemic of obesity, said the diabetes association in marking November as Uiabetes Awareness Month.

"Think of the development of [type 2] diabetes as a spectrum," said Dr. Lucy Mastrandrea, pediatric endocrinologist at Women and Children's Hospital and a diabetes researcher at the University at Buffalo. "You go from initially being overweight, where the insulin that your pancreas makes can't work as well, so it makes more and more.

"Over time, the degree of resistance increases to the point where the pancreas can't keep up," Mastrandrea said. "When that happens, you see prediabetes, the earliest stage.

"If you can catch people in that stage and counsel them about diet and exercise -- which is known to work to decrease the risk of developing diabetes -- then you can prevent them from getting diabetes."

Risk factors

Obesity is the single biggest risk factor for developing [type 2] diabetes, followed by genetics and a sedentary lifestyle, said registered dietitian and certified diabetes educator Jeff Ensminger.

"Other than genetics -- and we don't know how much of that is environmental or hereditary -- a majority of people could prevent type 2 diabetes when found early enough, which is why we try to be very aggressive with people who are deemed prediabetic," Ensminger said.

"Without any lifestyle modifications, at least 75 percent of prediabetics will progress to full-blown diabetes within five years," said Ensminger.

Prediabetes is diagnosed with one of two blood tests:

--A fasting plasma glucose test, usually performed in the morning, requires an eight-hour fast (no food or drink except water), after which a blood draw is performed. --A two-hour oral glucose tolerance test (OGTT), in which a patient drinks 75 grams of glucose, and a blood draw is taken two hours later.

The online Diabetes Risk Test (available at www.diabetes.com/index.html) poses questions about weight, age, family history and other potential risk factors for type 2 diabetes.

"What's really scary is that 12 years ago, the projection for diabetes worldwide was 200 million people," said Ensminger of Propel Health with offices in West Seneca and North Tonawanda.

"Seven years ago, it was 300 million people. Now, there are thoughts that by 2030, one in three Americans potentially could have a glucose abnormality and potentially diabetes. The thing is, we have such a growing rate of obesity at all age groups, and people are getting heavier younger."

African-Americans, Hispanics, Native Americans and Pacific Islanders are at increased risk, as are women who have had gestational diabetes or women whose baby weighed more than 9 pounds at birth.

Younger patients

"We used to think of type 2 as adult-onset diabetes, and that certainly is no longer the case," said family nurse practitioner Lauralee Sprague of TLC Health Network. "We're now seeing adolescents who have type 2 diabetes, and I think there's a few reasons for that. For one, our lifestyles as Americans. We eat a poor diet. We don't get regular physical activity. A good percentage of us are overweight. As health care providers, we are much more aware of that, and we do a good job screening patients earlier."

Telling a patient he or she is overweight is never easy, said Sprague, who works in Gowanda.

"It's especially difficult in pediatrics, telling a parent their child is overweight," Sprague added. "We use the growth curve. Sometimes patients don't realize how heavy they are. It's not about vanity. It's a health concern."

At the Endocrinology-Diabetes Department at Women & Children's Hospital, Mastrandrea estimated 50 percent of her practice is treating children with diabetes. Ten to 15 percent of those children, she said, have type 2 diabetes, and obesity is a significant problem.

"You want families to be doing something that is sustainable for a lifetime," said Mastrandrea. "In pediatrics, it's important not to exclude any particular food group, because children are still growing. So if you restrict carbohydrates or fats, you're putting them at risk of having growth disorders."

To lose a pound a week -- when your intake is 3,000 calories a day, Mastrandrea said you should decrease your intake by 500 calories a day, which is a lot for kids.

"The time is ticking," said diabetes counselor Ensminger. "When you're looking to slow down the possible progression to diabetes, you're looking at the amount of food, and a chronic offender is really excess portions."

Lifestyle change

Betty Crowell, 56, of Fredonia, was diagnosed in early September with prediabetes at the Gowanda TLC site after a test determined her blood sugar was elevated over a three-month period.

"I did suspect there was a chance of it because I did gain a lot of weight," the 5-foot-6 Crowell said. "I was up to 270 pounds. I just got to a point where I was eating everything in sight. I really had to get a grip on reality. As soon as I got the diagnosis, I said: 'That's it. I don't want diabetes.' I started writing down everything I was eating every day."

Crowell met with a diabetic teaching nurse at Brooks Memorial Hospital in Dunkirk, who advised her to lose at least 10 percent of her body weight, and moderately exercise five times a week for 30 minutes a day.

"She taught me how carbs turn into sugar and how to lower my carb intake," Crowell said. "Now low-fat cottage cheese is my friend. I buy sugar-free Jell-O pudding that's 60 calories, and sherbet cups that are 80 calories."

Crowell has lost 30 pounds since September.

In 2002, the New England Journal of Medicine reported that exercise combined with diet changes can substantially cut blood-sugar levels in prediabetics. The Diabetes Prevention Program study involved 3,234 prediabetics who were assigned to one of three groups. One took the diabetes drug metformin, a first-line drug for the treatment of type 2 diabetes. The second group took a placebo, while the third exercised and changed their diets. The diet/exercise results were so remarkable, the study was stopped so all participants could reap the benefits of behavior modification.

Copyright (c) 2010, The Buffalo News, N.Y. 

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