Blogfinger

Good Morning Dr. Paul Goldfinger. Here are today’s top stories. Friday, January 22, 2016

Fasting blood sugar chart

CBS News reports on a public service ad campaign to encourage people to be checked for prediabetes launched by the American Medical Association, the American Diabetes Association, the Centers for Disease Control and Prevention, and the Ad Council.

HealthDay (1/21,)  reports the message of the campaign is “no one is excused from diabetes.” It also includes “a short online test at DoIHavePrediabetes.org.” that “can also be taken through texts and interactive TV and radio announcements.” The CDC issued a news release announcing the campaign, in which AMA President-Elect Dr. Andrew W. Gurman, MD, said, “As soon as someone discovers they may be at risk of prediabetes, they should talk with their physician about further testing to confirm their diagnosis and discuss the necessary lifestyle changes needed to help prevent type 2 diabetes.”

MedPage Today (1/21, ) reports that Dr. Gurman explained the reason for the campaign: “There are 86 million people in this country who have prediabetes, and 90% don’t know it,” adding, “we need to do something to make people aware of this condition and its risk.” The AMA is also seeking to raise awareness among physicians, “because they may have lots of people coming into their office and saying, ‘I just took the prediabetes test and I think I have it,’” said Gurman.

Blogfinger medical commentary:  By Paul Goldfinger, MD, FACC.

This public service ad campaign is about “prediabetes,” the latest medical issue to strike fear into the hearts of the public. Above, a doctor calls this a “diagnosis.”  Another calls it a “condition.”  But they are all careful not to call prediabetes a “disease.”  It actually is a state of awareness where early detection can result in a prevention program to reduce the risk of  type II diabetes.     In fact, 15-30% of prediabetics eventually get type II diabetes.

Prediabetes  is a name given to a borderline abnormal blood test coupled with the threat that the abnormality will give rise to overt diabetes and to heart disease.Those who are at highest risk of having prediabetes are obese, sedentary, hypertensive males, age 40-60, with a positive family history of diabetes.   The PR buildup will include a massive barrage of ads on TV, internet, doctors offices and elsewhere which will scare people with what amounts to a real concern, but it is not actually a disease, making this PR campaign somewhat unusual.   Maybe it is like the campaign to take BP readings in dental offices or shoe stores.  That way you can identify those with borderline high blood pressure readings who are not quite hypertensive—-ie prehypertensive.

In fact prediabetes has no symptoms, no physical findings, no medicines to take,  and no clear endpoint for therapeutic success except for a normalization of blood sugar levels.  It is really an idea about preventing a disease, diabetes, which can cause death and disability.  Prediabetes, a circumstance that can be found in millions of people,  is certainly a situation worth your attention.  So let’s put it into perspective.

There is type I  diabetes (insulin dependent) and the much more common, but less serious,  type II  (non-insulin dependent or “maturity onset” diabetes.)    The main worry with diabetes is generally not the elevated blood sugar levels (although that could become a problem; ) it is the risk of vascular complications including heart attack, kidney failure, stroke, blindness or amputation. Treating prediabetes is supposed to reduce the risk of clinical diabetes–type II.

The diagnosis of prediabetes is made with blood tests that measure blood sugar levels in a few different ways.  The best test is the A1C  (aka glycohemoglobin test) which averages blood sugar levels over time instead of in a snapshot as occurs with the fasting blood sugar test.  Normal A1C is less than 5.7%; prediabetes is 5.7-6.4% and diabetes is over 6.5%.

If you are said to have “prediabetes,” the usual recommendations include preventive measures which you  would want to do anyhow.  Number one is weight reduction.   Then comes exercise and specific dietary advice.  Control of all cardiac risk factors would be advisable also including BP control, stop smoking, cholesterol treatment, stress reduction, etc.

The Joslin Diabetes Center ( www.joslin.org/info/what_is_pre_diabetes.html  )   at Harvard Med. School says that weight reduction is the most important preventive measure.  They say that calorie reduction is more important than sugar intake. Below is their simple dietary advice if you have prediabetes, but it is good advice for anyone:

—-eating more foods that are broiled and fewer foods that are fried.

—-cutting back on the amount of butter you use in cooking.

—-eating fish and chicken more, and only lean cuts of beef.

—-eating more meatless meals, or re-orienting your meals so that your dinner plate has more vegetables, fruit and starches on it, and less meat.

This is what they say at Joslin, “The solution isn’t “avoid foods with sugar in them.” Rather, you need to lose weight if you are overweight, cut back on portion sizes, and plan for those occasions when you eat a small piece of cake or pie.”

So the latest celebrity disease is upon us, and the treatment is the same as what prevention minded docs have been advocating right along, but another dose of awareness and education could wake up a lot of future diabetics.