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Borderline diabetes is a term historically used to describe blood sugars that are elevated but not yet high enough to confirm a diagnosis of diabetes. The term was not clearly defined and no specific treatment was recommended, so people often were not sure how to manage their condition.
In recent years, terminology has changed from borderline to pre-diabetes, which has clearly defined lab values and established treatment recommendations. Screening for pre-diabetes can help identify those at high risk of diabetes so that recommendations can be made to prevent or delay progression to type 2 diabetes.
American Diabetes Association estimates that 1 in 3 adults have pre-diabetes. Many are not aware of this condition because it has no obvious symptoms. Risk factors for diabetes include family history, obesity, sedentary lifestyle and presence of health problems such as high blood pressure, high cholesterol or history of gestational diabetes.
Without identification and treatment, pre-diabetes will often progress to type 2 diabetes within five years. The seven-question pre-diabetes risk test can be taken online at www.diabetes.org, the official website of the American Diabetes Association. After the test, you get an immediate risk score and discussion of your risk factors, which you can print and take to your health care provider. Providers can discuss your risk status, order lab screening tests and make recommendations for management of pre-diabetes.
Lab tests offered for screening may include an A1C test, fasting blood sugar test or glucose tolerance test. Each of these tests has different purposes in making a diagnosis. The A1C test estimates blood sugar levels over two to three months, while a fasting blood sugar test measures a single point in time. Glucose tolerance testing is often done during pregnancy to evaluate for gestational diabetes, a risk factor for type 2 diabetes later in life. Providers also may offer screenings based on recommendations from the U.S. Preventive Services Task Force that are based on age and health condition.
Once a pre-diabetes diagnosis is confirmed, current recommendations include lifestyle changes and in some cases, medication. Lifestyle changes often help to delay or prevent the progression to type 2 diabetes. Increasing physical activity and implementing a healthy meal plan can be very effective in achieving a healthy weight. It can be difficult to make these changes without instruction and ongoing support.
Our community is fortunate to have many resources to help meet this need. The National Diabetes Prevention Program, established and researched by the Centers for Disease Control, determined that people who successfully complete the program can reduce risk of progressing to type 2 diabetes by at least 58 percent. Goals of these programs include helping participants achieve weight loss of 5 to 7 percent and increasing physical activity to 150 minutes per week. The impact of this can be seen for years. (Ref. https://www.cdc.gov/diabetes/prevention/prediabetes-type2/preventing.html).
Wilson County Health Department and the Wilson YMCA offer NDPP programs to people with pre-diabetes. Wilson Medical Center offers outpatient nutritional counseling for those who prefer individual instruction. Education may be a covered benefit of commercial insurance and people with Medicare B.
Wilson Diabetes Education and Support group is another source of support and information. Meetings are held at Wilson Medical Center and facilitated by a certified diabetes educator and a dietitian. Topics for this year include exercise, reading nutrition labels and grocery store tours. Visit www.wilsonmedical.com/community/events for the meeting schedule and topics.
If you are concerned about your risk for pre-diabetes or diabetes, please consult with your health care provider. Early detection and lifestyle changes can make a world of difference in your long-term health. Need a primary care physician? Call 800-424-DOCS (3627) to connected to one today.
Martha Gurley, RN, is a certified diabetes educator at Wilson Medical Center.