Educational Program Focuses on Diabetes Prevention
Disease can be avoided if early signs are followed by lifestyle adjustments
Mike McLean
Journal of Business

An arm of Inland Northwest Health Services is offering a fledgling education program aimed at raising awareness that the most common type of diabetes can be prevented for many people at risk of developing the disease. 

The program, launched by INHS's Community Wellness unit, involves a two-session course developed earlier this year at the request of physicians here who were seeing a growing number of patients who have what's called prediabetes, says Jennifer Polello, health education manager at CHER.

Prediabetes is diagnosed through blood-sugar levels that are above the normal range but not high enough for a person to be diagnosed with diabetes. People with prediabetes are at great risk of developing type 2, or adult-onset, diabetes, Polello says. Yet, too many people with prediabetes don't take it seriously enough because it's not diabetes-yet, she says.

"We're trying to get people out of denial," Polello says. "If they manage prediabetes with diet and exercise, they can control it, but too many people think it will go away."

In most cases, however, prediabetes will lead to type 2 diabetes for people who don't make certain lifestyle changes, beginning with diet and exercise, she says.

The American Diabetes Association (ADA) says 57 million Americans, or about 19 percent of the U.S. population, are prediabetic. It's estimated that 70 percent of those people will develop diabetes, says Lisa Randall, a certified diabetes educator involved in the program.

"However, if you don't do anything, it's more like 100 percent," Randall says. "The 30 percent of the people with prediabetes who don't develop diabetes have gone through a lifestyle change."

Type 2 diabetes, formerly known as non-insulin-dependent diabetes, usually begins with insulin resistance, a disorder in which the body doesn't use insulin properly, and the pancreas gradually loses its ability to produce insulin, says the U.S. Centers for Disease Control and Prevention (CDC). Type 2 diabetes accounts for at least 90 percent of all diagnosed cases of diabetes.

Type 1 diabetes, previously called insulin-dependent, or juvenile-onset, diabetes, develops when the body's immune system destroys pancreatic function, the CDC says. There are no known ways to prevent type 1 diabetes.

Currently about 8 percent of the U.S. population has diabetes of one form or the other, the ADA estimates. That percentage is expected to rise dramatically. The association estimates that one in three children born since 2000 will develop diabetes.

Deterring diabetes is where education and intervention can come in, Polello says, adding, "People can prevent the slide from prediabetes to diabetes."

CHER's course provides an opportunity for those recently diagnosed with prediabetes to learn what can be done to avoid the progression to type 2 diabetes, she says.

The classes teach meal-planning strategies and the importance of exercise and their impact on blood-sugar levels and overall health, Polello says. The classes are held monthly and rotate among Spokane-area hospitals. No doctor's referral is needed.

People who have prediabetes may feel fine, and they often don't go to the doctor until the condition has progressed to type 2 diabetes, says Debbie Belknap, a registered nurse and certified diabetes educator who helps instruct the prediabetes course.

Prediabetes, however, often is accompanied by high blood pressure and high levels of cholesterol, which can contribute to risk of heart disease and stroke, Belknap says.

It's important to address prediabetes before other health complications occur, she says, adding that by the time it develops into type 2 diabetes, some cardiovascular damage likely already has occurred.

"People who have heart attacks often are people who have prediabetes," Belknap says.

A physician can perform two blood-sugar tests to determine whether a patient has prediabetes-the fasting glucose test and the glucose tolerance test, Belknap says.

After overnight fasting, a blood-sugar level of 100 to 125 milligrams per deciliter is considered prediabetic. A glucose tolerance test two hours after the beginning of a meal that results in a reading of between 140 and 199 milligrams per deciliter also is considered prediabetic.

"If you don't have diabetes or prediabetes, you should never have high numbers," Belknap says.

In addition to elevated cholesterol levels and high blood pressure, risk factors for developing prediabetes include elevated blood fats called triglycerides, low HDL (good cholesterol), a large waistline, a family history of type 2 diabetes, physical inactivity, and prior gestational diabetes, the ADA says.

Diet and exercise

Americans today are developing type 2 diabetes at an earlier age than they did in previous generations, Randall says.

"We're a fast-food society," she says. "A couple of generations ago, people didn't have fast food. They had gardens. They had to work for their food."

To help with diabetes prevention and control, the ADA recommends that people cut back on high-calorie snack foods, beverages, and desserts, and replace them with a variety of fruits and vegetables.

A balanced diet also includes moderate servings of whole-grain foods, lean cuts of meat, and nonfat dairy products, the association says.

There are some medications, such as metformin, that can help control blood-sugar levels for people with prediabetes, but medications usually should be secondary to lifestyle changes, Belknap says.

"People want a magic pill," she says. "The closest thing to a magic pill is exercise. The physiology of exercise is magic for preventing diabetes."

Exercise boosts the body's metabolism and helps insulin enter the body's cells, Belknap says, adding, "That allows us to use the food that we eat for energy."

Exercise is something as simple as a brisk walk around a park, she says. The American Diabetes Association recommends 30 minutes of moderately intense exercise a day.

"Even two minutes a day can make a big difference, but you have to do it regularly," Belknap says.

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