Sep 11, 2015 — Pre-diabetes is much more common than you might think: Diabetes expert Dr. Tim Graham says about forty percent of Americans are pre-diabetic and less than ten percent of those people even know they have it. Pre-diabetes doesn’t have any symptoms, and sometimes it affects even people with healthy habits and a good BMI. But the good news is pre-diabetes is reversible. Dr. Graham talks about what it means to have pre-diabetes and what you can do to prevent it from worsening.

Interview

Interviewer: Pre-diabetes. What is it, what are the symptoms, and what can you do about it? Odds are you have it. We'll talk about that next on The Scope.

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Interviewer: Dr. Tim Graham is a diabetes expert at University of Utah Health Care. As a matter of fact, he's the Medical Director of the Diabetes, Obesity, and Metabolism Programs for University of Utah Health Care. Pre-diabetes: epidemic? Is that fair to say?

Dr. Graham: Oh yeah, that's about as fair to say as anything you could ever call an epidemic in all of medicine. So we've got right now about 40% of people in the United States affected with pre-diabetes, and probably less than 10% of those people even know that they have it. So the vast majority have no idea they have this condition. It is asymptomatic so people really don't have symptoms that would prompt them to go see a doctor to get checked out.

Interviewer: And I have to say, I consider myself to be a fairly healthy individual. I walk my dogs a half hour each day. I watch what I eat, for the most part, but I had my glucose done and from what I understand I have pre-diabetes. It was a shock to me.

Dr. Graham: Yeah, yeah. You just shared that with me that your blood sugar was exactly at the level where we call people as having pre-diabetes. The condition is called impaired fasting glucose when you have a blood sugar, a fasting blood sugar of 100 milligrams per deciliter or more. And if you get up to 200 we call it diabetes.

Interviewer: And what does that mean to me? What road am I on?

Dr. Graham: Well, the problem with having been diagnosed with pre-diabetes is you've got roughly, over a five year period, you've got a roughly 30% chance of developing diabetes itself. And so even in the short-term, and to me really five years is a fairly short-term. It's looking out a few years. You've got a good chance of getting diabetes. Now, the important thing is that this can be completely prevented. It can be intervened on, especially by taking on some lifestyle modifications. So if you could do some changes where you lost a few pounds and started increasing your activity, you could prevent it by 50 to 70%.

Interviewer: You're kind of like the ghost of Christmas future right now, aren't you?

Dr. Graham: That's right.

Interviewer: "This is your fate unless you change your ways." So let's talk about pre-diabetes. It means you've got a pretty good chance of having diabetes and that's not fun.

Dr. Graham: No, it's not. I mean, if you haven't had a relative with diabetes, the problem is that the blood sugar elevation that you get with diabetes damages many different tissues. So it causes eye problems. It causes kidney problems, and it causes nerve problems. The nerve problems can lead to amputations. The eye problems can lead to blindness. In fact, diabetes is the number one cause of preventable blindness in the United States. And the kidney problems can lead to dialysis. So it's a really miserable set of things that you can eventually develop if you develop diabetes. Also, it increases your risk of heart attack and stroke dramatically.

Interviewer: So it's such a big deal, as a matter of fact, that here at the University of Utah Health Care that there is a whole program now dedicated to identifying and helping people deal with pre-diabetes.

Dr. Graham: Yes, that's right. Right now we are working with our community clinic physicians to identify people at highest risk and start screening people across the board. So if you have any concern based on your weight, your lack of activity, or you've got a strong family history of Type II Diabetes, I would really encourage people to talk to their physicians.

Interviewer: Even if you don't, because I have none of those things. I actually had another physician tell me, "I don't understand why this physician's doing this test on you. You look like you're a healthy guy. How old are you? It's pointless," but it wasn't.

Dr. Graham: You know, you're sort of like the poster child of the sort of movement for universal screening. It's exactly patients, like you, who don't even meet the sort of classic risk factors who probably make a good argument for why we should be screening the whole population.

Interviewer: So you go into your physician, you should probably request what type of a test?

Dr. Graham: Typically, we start with two things. One is a fasting glucose and the other is a hemoglobin A1C. Some people call that last one an HBA1C. So the fasting glucose can tell you, basically, when you're not eating what your blood sugar levels look like. The hemoglobin A1C, however, gives you information about what your blood sugars look like over a three-month period. So if you've been high after meals, the hemoglobin A1C may pick that up whereas a fasting glucose won't really give you that information.

Interviewer: So get those tests done. If they come back as they did for me, then exercise, dietary things that you can do to correct that. And there are probably a lot of resources on the web to find.

Dr. Graham: So we really like to start people with a formal lifestyle intervention program. So the old days of the doctor saying, "Hey, you need to exercise more and eat better," and then sending the patient out the door are over. So what we now have are programs that we get people involved with. They're community-based programs. The one that we run here is a version of the National Diabetes Prevention Program. You'll sometimes hear the term "DPP" and we're the first program of this sort in the state of Utah. We're actually backed by the Centers for Disease Control and the NIH in our efforts to do this.

And what it involves is people coming on a weekly basis for about 16 visits where they learn healthy eating approaches, exercise approaches, stress reduction approaches. And then they continue to follow up with the program for a total of one year. And that program alone has been shown to reduce the development of diabetes by about 50% over a three to five year period. And then in older people, over the age of 65, by 71%. So it's pretty dramatic.

We also have medications. One of them is Metformin that can be taken, either in conjunction with that or alone for people who may not be able to adhere to the lifestyle modification. But we really think people should be doing the lifestyle.

Interviewer: As the poster child, I'm going to go ahead and say this. I understand nutrition. I understand how to eat healthy. These are things that I get. I understand exercise. I used to be a trainer at a weight room and never expected that it would happen to me. I don't want to freak people out, but I think it's just a good thing to know so you can start making some lifestyle changes. Like, my job right now I sit a lot. I don't really move around a lot. I get home, I sit more.

Dr. Graham: And that's a really underestimated problem in the United States. So there are people who are not obese or not even overweight who may eat fairly healthily, but at the same time because of their significant amount of inactivity as well as the effects of aging, you can develop pre-diabetes.

Interviewer: Are there any final thoughts that you have, anything that I forgot to ask you that you feel compelled to say, that you feel our listeners should know?

Dr. Graham: Yeah, you know, this is one of those rare things where if you get it, it's not too late. You can actually reverse the disease process. So I think a lot of people fail to take action on their health because they almost dread finding out they've got a problem. This is one of those situations where you want to know if you have this problem because you can really take steps that will make a huge difference.

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