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By Melissa Tennen, HealthAtoZ writer
Obese people might not think they are at risk for type 2 diabetes, says a survey by the American Diabetes Association (ADA). This is worrisome, says Martha Funnell, M.S., R.N., C.D.E., past president of Health Care and Education for the ADA and a diabetes nurse educator at the University of Michigan's Diabetes Research and Training Center. She talks about the survey, a condition called pre-diabetes and what you can do.
What did the survey show?
Martha Funnell: We surveyed 600 Americans over age 18. We asked them about efforts to lose weight and their health. The most upsetting thing we found was that people knew obesity was a risk factor for diabetes, and they knew they were obese. But only half thought they were at risk for diabetes.
Why do people think they're not at risk?
Funnell: People don't like believing that bad things are going to happen to them. It's the same thing with smoking or why some people don't wear seatbelts. We like to think we are exceptions to the rule. Denial is a powerful thing.
What are the risks for diabetes?
Funnell: Family history is the biggest risk factor and obesity is second.
We're just now starting to recognize this epidemic of obesity and its role in type 2 diabetes.
Health care professionals are used to focusing on family history. And now with the epidemic of obesity, they are looking at obesity as a big risk factor. People with obesity without a family history of diabetes are getting it.
Why don't people just lose weight and exercise?
Funnell: It's hard to take care of your weight. The Diabetes Prevention Program (DPP) study showed people with pre-diabetes can prevent the development of type 2 diabetes by losing weight, eating a healthy diet and exercising. People may even be able to return their blood glucose levels to the normal range. While the DPP also showed that metformin could delay the development of diabetes, diet, weight loss and exercise worked better. Doing 30 minutes a day of moderate physical activity along with a 5 to 10 percent reduction in body weight produced a 58 percent reduction in diabetes.
It's easy to think the risk is not very serious just because it can easily be treated with lifestyle changes.
Why aren't people getting the message?
Funnell: How many times a day do you hear you have to lose weight, watch what you eat, exercise? People tend to tune it out.
How can you tell if you have pre-diabetes?
Funnell: There really aren't symptoms. Guidelines say to get a routine blood test every three years. It's a very simple blood sugar test, and it can be ordered by your doctor or done in the office.
What is the different between diabetes and pre-diabetes?
Funnell: Pre-diabetes is identified when a person's blood glucose levels are higher than 100 mg/dL but not high enough for a diagnosis of diabetes. About 11 percent of people with pre-diabetes in the DPP control group developed type 2 diabetes each year during the average three years of follow-up. Other studies show that most people with pre-diabetes develop type 2 diabetes in 10 years.
Before people develop type 2 diabetes, they almost always have pre-diabetes. At least 16 million people in the United States (15.6 percent of the population), ages 40 to 74 have pre-diabetes. Sometimes with pre-diabetes, long-term damage is being done, especially to the heart and circulatory system.
Does everyone who gets diabetes have pre-diabetes first?
Funnell: We don't really know if everyone automatically converts over to full-blown diabetes. I'm not sure we know the answer. It hasn't been studied enough.
People have known about impaired glucose for many years. The diabetes prevention study followed a group of patients for years. We need more data on this, however.
Should you get tested and how often?
Funnell: Guidelines say to get a routine blood test every three years. It's a very simple blood sugar test, and it's done in the doctor's office.
Do people continue to have misperceptions after they've been diagnosed?
Funnell: People get type 2 diabetes and don't always understand that they have a serious illness that can affect the quality and length of their lives. They think they are not at risk for complications. They think it's one of those things that happen as you get older.
I've had some people tell me, "I have diabetes, but it's not the serious kind."
Does everyone understand the gravity of the diagnosis?
Funnell: Not everyone responds with the attitude that it isn't serious. Many patients become depressed. Depression is two times as common among people with diabetes.
Are doctors catching the depression?
Funnell: It's easy to overlook. If you are depressed, it's hard to think about exercise, glucose control, weight and diet. You aggravate the high blood sugar, which worsens the depression. Depression tends to be undertreated.
When you are depressed, you are not able to take care of yourself as well.
It gets back into the whole survey. Pre-diabetes is the phase where you can really intervene and prevent diabetes.
Are more people becoming aware of pre-diabetes?
Funnell: I think we are getting the word out about pre-diabetes and weight and its effect on diabetes. We know you can really prevent or delay diabetes by controlling your weight and with exercise. There really aren't any symptoms. That's part of the problem. Only through a blood test can you know. It's not like the symptoms of diabetes where you may feel very tired and you are urinating often.
Do doctors discuss the risk of diabetes with their patients?
Funnell: Now we have a new emphasis on diabetes prevention. I think one of the reason doctors didn't discuss it enough is that we used to think there wasn't anything we could do about pre-diabetes. You just had to wait and see if you got it. Now that obesity rates have increased, it gets more attention and we know that with diet and exercise, diabetes may be prevented or its onset delayed.
Are parents of obese children aware of the risks?
Funnell: The fact that children are now getting type 2 diabetes is getting a lot of media attention. Obesity in children is an issue that is coming out. But I think parents are more worried cosmetically and socially. I'm not sure they understand the risk for diabetes.
One of things that parents need to understand is that their children can develop diabetes.
What can someone do?
Funnell: One of the things we need to do is help promote weight loss and help people lose weight by offering the kind of support they need. It's not going on a diet for a week. It's about making long lasting changes. You can work with a nutritionist, a nurse, a social worker, or even peers for support. It's not a one-time thing; it's not a two-week diet. You need to make lifestyle changes. Once you lose weight, the goal is to keep it off.
It's really about making changes. It's how you eat each day and do the things to fight diabetes.
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External Source
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The American Diabetes Association
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This article was reviewed and updated June 2007.
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