Early identification may be key to stop type 2 diabetes

What's the best way to stop type 2 diabetes?

Find it before it becomes a problem.

"The phrase I use is prevention by detection," said Joseph Aloi, M.D., section chief of endocrinology and metabolism at Wake Forest Baptist Medical Center in Winston-Salem, North Carolina.

It's no secret that diabetes - elevated blood glucose levels caused by the body's failure to produce enough insulin (type 1) or properly use it (type 2) to process sugars - has reached epidemic proportions in the United States. According to the federal Centers for Disease Control and Prevention (CDC), approximately 29 million people in this country have diabetes, with type 2, formerly known as adult-onset diabetes, accounting for more than 90 percent of those cases. If left unchecked, diabetes can lead to serious complications, including heart disease, kidney failure, stroke, blindness and the loss of toes, feet and legs.

What's less known is that nearly three times as many Americans - roughly 86 million - have prediabetes, a condition where blood sugar levels are above normal but still below the threshold for type 2. Prediabetes generally doesn't produce noticeable symptoms, so the vast majority of people with the condition - nine out of 10, according to the CDC - don't even know they have it.

But the progression from prediabetes to type 2 is not inevitable, and there's a common blood test called the A1C that can determine whether a person's blood glucose levels require attention.

"Prediabetes is a great opportunity to prevent diabetes," Aloi said. "The A1C test really helps you hone in on whether there's a problem, and if there is, to start addressing it. It's a simple, inexpensive test that doesn't require any special preparation but can provide a lot of good information."

Formally the glycated hemoglobin test, the A1C measures the percentage of glycosylated hemoglobin - think sugar-coated red blood cells - in the bloodstream, which indicates a person's average blood glucose level over the previous three months. The A1C provides a more accurate assessment than a fasting plasma glucose test, which uses a blood sample taken from a person who has abstained from food and drink for at least eight hours.

"The fasting test is a snapshot of what your blood sugar level is at that one specific time, which may or may not be representative of what's really going on," Aloi said. "The A1C test, on the other hand, is sort of a report card for the past 90 days, and that's a more valuable indicator."

So who should get tested?

Various institutions and organizations offer different recommendations but generally agree that you should at least discuss blood glucose screening with a doctor if you have any of the common risk factors for diabetes, even if you don't have any symptoms. As these risk factors include being over age 40, being overweight or obese, being physically inactive, having a family history of type 2 diabetes, having high blood pressure, having low HDL (good) or high LDL (bad) cholesterol levels, and being of African-American, Hispanic, Native American, Asian-American or Pacific Islander descent, "almost everyone" should be tested, Aloi said.

"I believe my job is to help people make correct choices, and to do that they need to have good information," he said. "And part of that is screening for prediabetes and diabetes."

Should testing reveal elevated blood glucose levels, the development of type 2 diabetes can in the majority of cases be prevented or delayed though lifestyle changes such as weight loss, healthier eating and increased physical activity. There are also anti-diabetes medications, such as metformin, which helps the body use insulin more efficiently.

"We can't get rid of your genes or other things that may predispose someone to diabetes and we don't have a cure, but we do know ways to control it," Aloi said. "For most patients, especially if we're catching prediabetes, the changes they need to make can be small but still effective.

"Losing 10 to 12 pounds and walking 20 minutes a day can be better than medicine. Sometimes restricting carbohydrates or adding more fiber to the diet helps a lot, and for younger patients simply eliminating sugary drinks might be enough."

And while advanced type 2 diabetes can be also managed - or even put into remission - through treatment, the early identification of blood sugar problems is vital.

"You're obviously better off preventing the complications from occurring than trying to treat them," Aloi said. "I think it's extremely important to identify the people who are at risk of diabetes and to tell them: This is the track you're on. You should get out of the way of the train."