Type 2 diabetes: Better choices change the odds

Many people believe that a diagnosis of pre-diabetes is a one-way ticket to type 2. Drug Topics board member Fred Mayer says it ain’t necessarily so; people have more power over this outcome than they may think. To clear up some common misunderstandings, he has put together some information for you to share with your patients.

I was watching the Letterman show recently, when actor Tom Hanks revealed that he was diagnosed with diabetes. He joked that his doctor said he had “graduated” from high blood sugar (pre-diabetes) to type 3 diabetes. He also called his diagnosis “inevitable.”

“Tom Hanks has done people a favor by speaking out about his diabetes diagnosis,” said Dr. Jyoti Bhat, a specialist with Marin Endocrine Center. “It’s one of the most prevalent diseases in the world today, and anything that raises awareness of the causes and consequences of diabetes is a good thing.”

Dr. Bhat says that while the rise in diabetes is “alarming” - 25 million people in the United States have diabetes, and that number is growing daily - an even bigger concern is that most of them don’t know it.

“If Mr. Hanks’ revelation encourages more people to be tested or encourages more people to follow their doctors’ recommendations,” Bhat said, “then something important has been accomplished.”

Not inevitable

Like Hanks, many people believe that their diabetes is inevitable.

“For many individuals with pre-diabetes, it’s simply not true that it’s inevitable,” said Bhat. “If the condition is caught early, it is possible to delay or even prevent the onset of diabetes. That’s why it is so important to be screened early.”

Elevated blood sugar, which Hanks said he had been warned about since he was 34, is one of several conditions that might lead to impaired glucose tolerance, a pre-diabetic state, said Bhat.

According to Dr. Alan Rubin, UCSF endocrinologist and author of “Pre-Diabetes for Dummies,” a diagnosis of pre-diabetes means that you have 10 to 40 times the average risk of developing diabetes. But you can shift the odds.

Shifting the odds

Some people can stay in the pre-diabetic range all their lives and not develop diabetes.

They will still be at risk for complications such as neuropathy (nerve damage), kidney disease, cardiovascular disease, and vision impairment, however, so diet and exercise are still important to maintaining health and avoiding disability.

It may have seemed to some viewers that Hanks was too flippant about the possible consequences of his disease (he told Letterman, “Something’s got to kill us all”). Patients are motivated by more than mortality, Bhat said.

“Potential disability from diabetes can have a major impact on a person’s quality of life,” she said. “Regardless of how long they live, people want a fulfilling life as they get older.”

In fact, age is a major risk factor for diabetes, “compounded by the fact that people tend to gain weight as they age,” said Bhat. “But exercise and a healthy diet will not only reduce your risk at any age, they will contribute to a better quality of life as we get older.”

For those who know that they already have at least one of the risk factors for diabetes, Bhat pointed out that losing as little as 5% to 10% of their total body weight - just 10 to 20 pounds for someone who currently weighs 200 pounds - has proven benefits, reducing or even eliminating the need for insulin.

“Surprisingly, it doesn’t matter how heavy you are to start - a relatively minor weight loss can have a major beneficial effect,” Bhat said.

Type 2 diabetes

Fact: Lean people can get type 2 diabetes, too.

“It’s really about body fat distribution and body composition,” Bhat said. “Fat around the middle (the classic “apple shape”) is much more metabolically active than subcutaneous fat and fat carried in your hips and thighs (the classic “pear shape). That’s why waist circumference is an important measure of risk.”

“Very often, we see patients who have diabetes - probably have had it for quite some time - and simply had no idea,” Bhat said. “Many have nonspecific symptoms, so if they’re not looking for it, they won’t find out. The length of time you have diabetes or pre-diabetes before taking action will help determine your chances of preventing or reversing damage, so the earlier you are screened and take preventive steps, the better.”

Fact: Diabetes is controllable and it’s possible to live a normal life with it.

Many people do. However, uncontrolled diabetes can result in a significant decline in quality of life and independence. If you’ve been avoiding getting screened, ask yourself whether it’s worth the risk - do you want to live with a significant disability?

Fred Mayer, RPh, MPH, has devoted his career of more than 50 years to public health. He lives in San Rafael, Calif., where he is president of Pharmacists Planning Services, Inc., a nonprofit, consumer, public health, pharmacy, and education organization. E-mail him at ppsi@aol.com or visit ppsinc.org.