According to the federal Centers for Disease Control and Prevention, the prevalence of Type 2 diabetes mellitus continues to rise.
Type 2 diabetes results from an impairment of the body’s system to use insulin, known as insulin resistance, which leads to elevated and potentially toxic levels of sugar in the bloodstream. While there are many factors influencing risk for this disease, including family history of the illness, the rising prevalence seems related to the obesity epidemic in the United States.
Present statistics suggest that nearly 26 million Americans suffer from Type 2 diabetes and that nearly one-fourth of these remain undiagnosed.
The symptoms of diabetes mellitus include tiredness, vision blurring, excessive thirst and urination (including nighttime urination), weight loss and frequent infections. Because the factors lead to diabetes develop over time, many suffer abnormal blood sugar without obvious symptoms.
Recent changes in clinical recommendations have made the diagnosis of diabetes mellitus easier. Often all that is required is a simple non-fasting blood test called hemoglobin A1c that measures recent average blood-sugar levels. For those with risk factors such as obesity or family history of the disease, screening permits early diagnosis and may enhance treatment options.
Evidence now exists to support the understanding that insulin resistance exists well in advance of the onset of Type 2 diabetes. The disease process often takes years to manifest as various mechanisms exist initially to compensate for insulin resistance while maintaining normal or near-normal blood-sugar levels.
The recognition that minor blood-sugar abnormalities may precede the onset of diabetes by several years has resulted in criteria for diagnosing so-called pre-diabetic conditions known as impaired fasting glucose and impaired glucose tolerance.
People with pre-diabetes constitute the group with highest risk for developing diabetes, as these conditions represent a step in the direction of the disease.
The good news from studies such as the Finnish diabetes prevention study and the U.S. diabetes prevention program is that the progression to Type 2 diabetes mellitus can be delayed or possibly prevented through lifestyle modification. This reinforces the importance of screening and early detection among those at highest risk.
People with pre-diabetes may be able to reduce their risk by almost 60 percent during three years through a program of intensive lifestyle modification. There is some evidence that a common and safe diabetes medication, known as metformin, may contribute to diabetes prevention when combined with lifestyle changes.
The most beneficial lifestyle changes combine weight-loss goals with important dietary and exercise habits. Moderate physical activity – at least 150 minutes weekly – is advised. Dietary changes including a reduction in total daily caloric intake as well as reduction in consumption of concentrated sweets and fats are geared toward the goal of a 7 percent average weight loss. This is often best accomplished through referral to a structured diabetes-prevention program.
People at the highest risk for developing Type 2 diabetes mellitus, such as those with pre-diabetes, should be screened yearly for the disease.
Dr. Matthew A. Clark is a board-certified physician in internal medicine and pediatrics practicing at the Ute Mountain Ute Health Center in Towaoc.