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Laura Dolson

New Recommendations for Pre-Diabetes

By August 23, 2008

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bloodThe American College of Endocrinology recently came out with a statement of recommendations for managing pre-diabetes (PDF). In the title, the question is asked "When Do the Risks of Diabetes Begin?" The question is a crucial one.

The paper starts out by making it clear that the diagnosis of Type 2 diabetes is only one point on a continuum of the body's ability to process sugar, and that pre-diabetics (and in some cases even before the pre-diabetes cutoff) is risky. Some quotes: "Epidemiologic evidence suggests that...complications of diabetes begin early in the progression from normal glucose tolerance to frank diabetes." "It is clear that the risks of high blood glucose levels occur earlier than those at which we currently define as diabetes." "The intermediate state of pre-diabetes is not benign."

Among the problems associated with pre-diabetes are increased risk of heart disease, diabetic retinopathy, and "all-cause mortality". The paper points out that in one study, 8% of people with impaired glucose tolerance in the pre-diabetic range had diabetic retinopathy. I think the paper does a great job of outlining why it is so important to address the process of diabetes, which is going on long before the diagnosis of diabetes.

So, what can be done to treat pre-diabetes? Recommendations in the statement include reducing weight by 5-10%, 30-60 minutes of exercise at least 5 days per week, a low-fat "adequate fiber" diet, and possibly medication for control of blood glucose. There are target goals for blood pressure and LDL cholesterol as well.

Obviously, I am especially interested in the dietary recommendations. Notice that a low-fat diet is recommended, and then possibly medication for blood glucose control. Believe me, medication is much more likely to be needed if people are on a low-fat (read: high carb) diet! Why on earth don't they recommend lowering carbohydrates, which turn to sugar in the body and raise blood glucose? As recently pointed out by researchers and physicians , there is abundant evidence that carbohydrate reduction is effective in improving many of the problems associated with Type 2 diabetes. Note also a atudy in a recent Archives of Internal Medicine which showed no protection from diabetes from eating a low-fat diet.

The other thing that is missing from the recommendations, in my opinion, is advising home monitoring of blood glucose for pre-diabetics. As a pre-diabetic myself, blood glucose monitoring is a great way to understand how different foods affect my blood sugar, and it keeps me motivated to eat and exercise in a way to keep my blood sugar as close to normal as I can get it. If an organization such as the American College of Endocrinology started recommending this, perhaps more insurance companies would consider covering the costs of monitors and test strips.

Photo © Richard Cano

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August 25, 2008 at 2:39 pm
(1) Lahle Wolfe says:

I am glad to hear you are not afraid to disagree with the “experts.” I have type 2 diabetes. As my disease progressed from pre-diabetes into full-blown type 2 at age 23, I was told over and over to “just lose weight.” Repeatedly, I was handed ADA diets, Weight Watchers, and other high-carb, low-fat plans. This was the 1980s so of course “doctors did not know better back then.”

Wrong. They did. The NIH produced studies as early as 1981 that showed carbs had a detrimental effect on women with PCOS and those with insulin resistance. But this information was ignored then, and is apparently still being ignored.

I found information about low-carbing in 1987 on the Internet. Sold on the science, I went on Atkins and lost 150 lbs in 13 months. My lipid profile went from dangerous to perfect and my blood sugars were well-controlled.

I am appalled to see that low-fat plans are still being advocated by people in the diabetes health industry that should and DO know better by now. The ADA has back off some, but not enough.

The simply truth is that if I had been told to stop shoving carbs into my body at age 20, I would probably not have diabetes today.

Thank you for showing you are not only smarter, but care more about those of us with metabolic challenges than many well-meaning, ill-informed providers in the health industry.

Lahle Wolfe

August 26, 2008 at 10:23 pm
(2) Judy Barnes Baker says:

It all makes perfect sense if you look at the list of sponsors at the end.

Judy Barnes Baker

September 17, 2013 at 2:36 pm
(3) William Fuller says:

I enjoyed your blog! I have a friend expecting their first and this really helped them with some diet plans. I have also suggested to them to avoid deli meats due to the possible risk of infection. I had some spare time and created a free blog about some of my findings.

November 27, 2013 at 3:11 pm
(4) Karen says:

Way back in the mid-60s, as a nurse I went through the Virginia Maon Hospital’s diabetic program. Required for eveyone who worked there as VM had a leadin diabetic program. It was low-carb. High whole foods that included plenty of fruits veggies, proteins. At the time i thought that would be a perfect way for everyone to eat.

At that time the “fat fear” started becoming popular. Where before that it was common knowledge that it was breads, cakes, potatoes that made people fat!

I am very happy to see that we are coming back to common sense. Disappointed to see that the diabetic prevention encouraging low-fat/high carbs is supported by the CDC and the DPP.

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