Next, let’s discuss the progression of pre-diabetes to diabetes and how we might prevent it. According to one large study a little over 10% of people with pre-diabetes will progress to full-blown diabetes each year over the ensuing three years after diagnosis. That is a pretty significant risk and represents a major deterioration of health and leads to an eventual reduction of life expectancy, so it pays to take pre-diabetes seriously and do everything you can to prevent its progression.
So let’s go back to the three main causes of diabetes and talk about prevention of pre-diabetes progressing to diabetes. Well, we are back to your genes, your age and your weight. We can’t do much about our genes and our age, but once again we must do everything we can to control our weight to slow down and prevent the progression of pre-diabetes to diabetes. Aiming for a body mass index less than 25 is the right start. If you are already overweight then taking a serious effort at weight reduction is necessary. Recommendations often fall along these lines according to experts.
For a body mass index 23-25, reduced calorie intake, increase exercise, cut carbohydrates and aim to reduce body mass index by one or two points.
For a body mass index 25-30, enroll in a medically supervised weight loss program with more regular testing of hemoglobin A1c, structured dietary plans that reduce calories, reduce carbohydrates and aim to lower the body mass index to under 25 over a sustained period of time. Medications including prescription medications Belviq and Qsymia show a reduction in hemoglobin A1c and there is reduced progression of pre-diabetes to diabetes in the two-year Qsymia study. If your body mass index is over 27, ask your doctor about use of these prescription medications.
Body mass index 30-35, intensive medical therapy with structured calorie restriction, counseling, frequent testing and goal of reducing body mass index to 25. Use of prescription medications considered as above. Consideration should also be given to laparoscopic adjustable gastric band procedure, which the FDA has approved at the body mass index of 30 and above for people with diabetes or other obesity-related health conditions. Research has demonstrated reduction of hemoglobin A1c after the procedure.
- Body mass index over 35, intensive medical therapy with structured calorie restriction, counseling, frequent testing and goal of reducing body mass index to 25. Use of prescription medications considered as above. Consideration of approved metabolic and bariatric surgical procedures including the LAP-BAND, gastric sleeve and gastric bypass.