Prediabetes and Type 2 Diabetes
Diabetes is a huge topic, but the following is a short overview about the screening tests for type 2 diabetes and a few other facts about the condition.
Among the US population overall, crude estimates for 2018 were 34.1 million adults (18 yo or older) or 13.0% of all US adults had diabetes. An estimated 88 million adults (18yo) had prediabetes in 2018 (1). Type 2 diabetes is a disease characterized by insulin resistance rather than lack of insulin (like in type 1 diabetes). The US Preventative Services Task Force recommends that adults age 35-70 years old who are overweight or obese to be screened for diabetes (2). The American Diabetes Association recommends all adults age 45 years and older to be screened for diabetes or adults of any age be screened if risk factors are present (overweight or obesity, family history of diabetes, a personal history of hypertension and/or chronic kidney disease) (3). Screening for diabetes can be done via a fasting blood glucose measurement, blood test for Hemoglobin A1c, or through an oral glucose tolerance test (commonly used in screening for gestational diabetes). Most often, we use a fasting blood glucose or A1c level as these are simple tests to perform. A fasting glucose level of less than 100 is normal, 100-125 is prediabetes range, and 126 or above is diabetes range. For the hemoglobin A1c, a value of 5.6% or less is normal, 5.7-6.4% is prediabetes range, and 6.5% or greater is in the diabetes range. I particularly like the A1c test as it provides an average blood sugars over 3 months rather than one snapshot in time. A normal level for these tests is reassuring. A level in the prediabetes range suggests that the risk for developing diabetes in the next 5-10 years is high unless changes are made. A test in the diabetes range is often confirmed with another measurement before making an official diagnosis of type 2 diabetes.
Diabetes is an issue because of the potential downstream effects of elevated blood sugars including vascular disease (heart attacks, stroke, peripheral vascular disease), kidney disease, eye conditions (retinopathy), fatty liver, and neuropathy. Interestingly, we think prediabetes may contribute to these conditions as well. Based on recent studies, the ADA has recommended initiating treatment in the form of metformin for prediabetes to delay the onset of overt type 2 diabetes. The recommendation for metformin is also paired with recommendations about lifestyle changes to help with weight loss.
Patients with overt type 2 diabetes may have no symptoms. However, some patients with elevated blood sugars may notice symptoms such as increase thirst, increased urination, and/or blurry vision. Once type 2 diabetes is officially diagnosed, there are a number of medications beyond metformin that we may use. There are several classes of medications that are older and several that are newer (developed within the last 10 years) for type 2 diabetes. Depending on the blood sugars levels and financial situation, we can tailor the combination of medications to best fit each person’s situation.
Every person is unique when it comes to what level of weight gain can throw off their metabolic balance. I have patients who are in the normal range for weight, but have signs of prediabetes or fatty liver. I also have patients who are classified as obese, but have normal blood sugars. There are many nuances of diabetes that we are still learning about, but we are happy to discuss should any abnormal labs or symptoms arise.
References
1) National Diabetes Statistics Report 2020 from the CDC . Available at https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf
2) USPSTF. Prediabetes and Type 2 Diabetes Screening. August 24, 2021. Available at https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/screening-for-prediabetes-and-type-2-diabetes
3) ADA Standards of Care, (2018), Available at: http://diabetesed.net/wp-content/uploads/2017/12/2018-ADA-Standards-of-Care.pdf.
