Dr. Barajas: 'With prediabetes, there's still time to turn things around.'

Approximately 96 million American adults—more than one in three—have prediabetes. Yet, of those with prediabetes, more than 80% don’t know they have it. Without intervention, prediabetes often leads to type 2 diabetes and puts you at increased risk for heart disease and stroke.

“A prediabetes diagnosis doesn’t mean that you will definitely develop diabetes. There’s still time to turn things around,” said board-certified internist Francisco Javier Barajas, MD, FACP, of Erie Primary Care during a free online health lecture. He described how prediabetes is diagnosed and the practical steps you can take to prevent or delay the onset of diabetes.

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Watch “How to stop prediabetes from becoming diabetes"

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Elevated blood sugar levels

The pancreas releases a hormone called insulin. Its job is to move sugar (glucose) from the blood and into the cells for use as energy. When you have prediabetes, also called insulin resistance or glucose intolerance, the cells aren’t responding properly to insulin and your blood sugar becomes higher than normal. It’s not high enough, however, to be considered diabetes.

“Prediabetes is reversible. Positive results, however, are dependent on you making and sticking with the lifestyle changes recommended by your health care provider. This includes making healthy food choices, exercising regularly and keeping your weight at a healthy level," Dr. Barajas emphasized. "But once you’re a diabetic, you’re always a diabetic. This is not a reversible condition, and it puts you at an increased risk for complications.

Diabetes symptoms result from insulin not working as it should and include:

• increased hunger and thirst,
• frequent urination, and
• unexplained weight loss.

“Once a patient has these symptoms, they often have already progressed to a diabetes diagnosis,” Dr. Barajas warned.

Screening for prediabetes and diabetes

Often there are no symptoms to indicate to someone that he or she is prediabetic. For this reason, it’s important that patients are screened.

Screening for prediabetes and diabetes is recommended by the United States Preventative Services Task Force (USPSTF) for everyone 35 to 75 years old, who is overweight or obese. The American Diabetes Association recommends that everyone 45 years old or older—no matter their weight and for younger people who are overweight (a BMI of 25 or more)—or who have significant risk factors be screened for prediabetes and diabetes.

Dr. Barajas described three screening tests:

1. Fasting Plasma Glucose—usually done in the morning, the patient can’t eat or drink for at least eight hours prior to being tested. A fasting blood sugar level of 99 mg/dL or lower is normal,  while 100 to 125 mg/dL indicates you have prediabetes.
2. Hemoglobin A1c—tests sugar levels over the last 90 to 100 days. If your A1c is 5.7-6.4, you’re considered prediabetic. If your A1c is 6.5 or higher, it is considered diabetes. 
3. Oral Glucose Tolerance—is not often used, as the patient needs to stay in the lab while their levels are checked to see how they are tolerating the sugar they have been given.

“If your results are normal, the recommendation is to be screened every three years moving forward. If, however, you have experienced a weight gain, you will want to be screened sooner,” said Dr. Barajas.

Risk factors

Dr. Barajas explained those who are at an increased risk for prediabetes and diabetes may be:

• overweight (with a BMI of 25-29.9) or obese (with a BMI of 30 or more),
• have a first degree relative with type 2 diabetes,
• associated with a race or ethnicity that is more prone to have diabetes such as Asian, Hispanic/Latino, Black and Native American Pacific Islander populations
• more sedentary and not exercising, and/or
• experiencing other co-morbidities such as high blood pressure, high cholesterol, polycystic ovarian syndrome and other cardiovascular diseases.

“Those who have experienced gestational diabetes during pregnancy have up to a 50 percent increased chance of developing diabetes,” said Dr. Barajas.

Treating prediabetes

“We have found that as we are more aggressive with our prediabetes treatments, we are better able to prevent long-term complications,” said Dr. Barajas. He says once you find you have prediabetes, the goals are to:

• prevent or delay the onset of diabetes,
• preserve the function of your pancreas, which produces insulin
• prevent diabetes complications—classified as:
  • microvascular—in those with diabetes this can affect the eyes, nerves, organs and kidneys
  • macrovascular—these complications are related to heart attacks, strokes and peripheral arterial disease—poor circulation, and
• reduce the cost of diabetes care— according to Dr. Barajas, $1 of every $4 in U.S. health care is spent on caring for people with diabetes and the total cost rose 60 percent from 2007 to 2017.

Prediabetes treatment plans combine diet and physical activity to achieve weight loss. Also, if you are a smoker, smoking cessation should be an important part of your plan. The goal is to decrease sugar levels, improve cholesterol, and cardiovascular health. "In fact,” Dr. Barajas said, “studies show lifestyle changes can cut the risk of going from prediabetes to diabetes by about 58%.”

Exercise

Dr. Barajas encourages patients to include 150 minutes of moderate intensity aerobic activity each week—about 30 minutes five days a week—of anything that gets your heart beating faster, and 75 minutes per week of vigorous intensity aerobic activity. “Active walking is one of the best activities to start with,” he said.

You should also do muscle-strengthening activities at least two days per week.

Weight loss

“If you are committed to eating well and you start losing one to two pounds each week, you can reduce your A1c by 2% in three to six months,” said Dr. Barajas. He added, “This will control your sugar as well as your weight. Typically your blood pressure and cholesterol will improve, and this will lead to reduced cardiovascular risk. The goal,” he said, “is to lose 7% of your weight.”

Diet

Dr. Barajas said, "What I try to do with patients is what's called a 24-hour recall. Basically, I ask, 'What did you eat and drink over the last 24 hours?' to assess the patient's dietary intake." Next, he asks patients to name the foods they eat and like from this superfoods list. The emphasis is on adding superfoods to your diet, rather than focusing only on what you should avoid. "The goal is to help patients develop a diet that is appropriate, manageable and sustainable."

He then reviewed the foods with consistent evidence of promoting health and linked to lower risk of chronic disease: 

• Vegetables
• Whole fruits (not juices)
• Legumes (beans, lentils, peas, chickpeas, tofu, edamame)
• Whole grains (whole wheat products, brown rice, barley, oats, quinoa) 
• Nuts and seeds, 
• Fish (rich in omega-3 fatty acids)
• Other sources of omega-3 include walnuts, chia, flaxseed

Foods linked to higher risk of chronic disease:

• Processed meats (any meat that has been smoked, salted, fermented, or has added sodium: sausage, ham, bacon, pepperoni, cold cuts, deli meats)
• Unprocessed red meat (beef, pork, lamb, etc.)
• Added sugars (sugar-sweetened beverages, most commercial breakfast cereals, many breads, desserts)
• Refined grains (white rice, white breads, rolls, crackers, and other foods made with processed grains; note that “multigrain” does not mean whole grain – it usually means multiple refined grains)
• Ultra-processed foods (most commercial snack foods, chips, crackers, etc.)

Dr. Barajas noted that three main diets have been studied: Mediterranean, low-carb and low-fat. “The diet with the strongest evidence is the Mediterranean diet, which includes superfoods. But at the end of the day, all of them will improve your weight and sugar. Whichever one you can stick with, will be the right choice for you.”

Medications

Metformin is a medication that is being used to reduce the risk of prediabetes progressing to diabetes. Dr. Barajas again emphasized, “While medication can help some patients, such as those with significant obesity, lifestyle changes perform better than medicine.”

Bottom line: Lifestyle changes can reverse prediabetes

Dr. Barajas reiterated that with simple lifestyle changes, prediabetes can be reversed. "I've done it. It's a commitment that you got to make every, single day."

MAKE AN APPOINTMENT

Please visit the Erie Primary Care website or call 303-586-7258 for more information and to schedule an appointment with Francisco Javier Barajas, MD, FACP.

Click here to view/download a PDF of the lecture slides from his lecture.

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