Are You at Risk for Diabetes?

Learn who should be screened for diabetes and why

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By Athena Philis-Tsimikas, MD

You’ve probably heard that diabetes has become an epidemic in the United States. According to the American Diabetes Association, 18.8 million adults and children have been diagnosed with the disease, and another 7.0 million are yet to be diagnosed.

Despite the rapidly increasing number of cases, however, diabetes is not a disease that happens overnight. Most cases of diabetes are type 2, which develops over time as a result of lifestyle factors such as obesity and lack of exercise. Type 2 diabetes often begins as a condition known as prediabetes, in which a person’s blood glucose levels are higher than normal, but not yet elevated enough to qualify as diabetes.

Prediabetes is estimated to affect 79 million people in the United States, although most don’t even know they have it. Though it often has no symptoms, it can do serious damage. Many people with prediabetes will develop health problems commonly associated with diabetes itself, such as an increased risk of cardiovascular disease. Moreover, prediabetes is likely to lead to type 2 diabetes within 10 years.

Since the condition has few if any symptoms, how do you know if you have it? A blood test that measures the level of glucose or sugar in your blood can give you an answer. There are several tests used for diagnosis. Two require fasting for at least eight hours before testing to ensure that you don’t consume anything that may affect the test results (eating or drinking may raise your blood glucose levels). The fasting plasma glucose test (FPG) measures your glucose levels first thing in the morning after you have fasted during the night. A fasting blood glucose level below 100 milligrams per deciliter (mg/dl) is considered normal; 100-126 mg/dl is considered “at risk” for diabetes.

The oral glucose tolerance test (OGTT) measures your blood glucose once after you have fasted. Then, you will be given a special high-glucose beverage to drink; two hours after you finish it, your blood glucose levels will be measured again. At this point, a blood glucose level below 140 mg/dl is normal.

Recently, a newer non-fasting test, HbA1C, has been used to measure how well your average blood glucose has been controlled over a period of two to three months. This test measures the percentage of glycated hemoglobin, or HbA1c, in your blood. A normal value is less than 5.7 percent; a value between 5.7-6.4 percent puts you in the “at-risk” category.

Who should be tested? If you are age 45 or older and overweight, it’s a good idea to have a prediabetes screening at your annual physical exam. Adults of any age who have other risk factors for diabetes or prediabetes, including a family history of diabetes, high blood pressure, low HDL cholesterol, high triglycerides, or a history of gestational diabetes should be tested as well. Ask your physician if testing is right for you.

Does being at-risk mean you are destined to develop diabetes? No. By taking steps to reduce your risk factors, such as losing excess weight and increasing exercise, you can lower your risk of developing full-blown diabetes. The recent Diabetes Prevention Program (DPP) study sponsored by the National Institutes of Health found that losing just 5 to 7 percent of body weight helped people who had a higher risk of diabetes delay or prevent the disease. This weight loss, along with 30 minutes of daily moderate physical activity such as walking, reduced the onset of diabetes by 58 percent. In fact, some patients have even seen their blood glucose levels return to normal levels as a result of this treatment.