- The Washington Times - Monday, April 2, 2007

Five-mile daily walks through her Northwest neighborhood are delaying the onset of diabetes for 74-year-old Irish R. Stovall.

“It runs in my family, and thus far, I haven’t crossed over the line,” Mrs. Stovall says.

She was diagnosed with prediabetes eight years ago. She began exercising, changed her eating habits by cutting back on calories and adding more fruits and vegetables, and lost 50 pounds.

“If I don’t get my walk in during the day, there’s something not right,” she says.

Approximately 54 million people in the United States have prediabetes and are at risk for developing type 2 diabetes, heart disease and stroke, according to the American Diabetes Association (ADA), a nonprofit health organization based in Alexandria that provides diabetes research, information and advocacy. Diabetes, which affects 20.8 million people, causes a high level of blood glucose from the body not producing or using insulin, the ADA says.

Ninety percent to 95 percent of those with diabetes have type 2, or adult-onset, diabetes, says Dr. Alan Shuldiner, professor of medicine and head of the division of endocrinology, diabetes and nutrition at the University of Maryland School of Medicine in Baltimore.

“It’s extremely prevalent in the U.S.,” Dr. Shuldiner says. “The main reason is our lifestyle over the last 20 to 30 years has changed dramatically. We’re much less active, and food is abundant, especially food high in calories and fat.”

Type 2 diabetes and prediabetes cause the body’s cells to become less and less responsive to insulin and to require higher levels of the hormone, says Dr. Joshua Cohen, associate professor of medicine for the division of endocrinology and metabolism at the George Washington University Medical Center in Northwest.

Type 1 diabetes, alternatively, is an autoimmune disorder that causes the body to destroy insulin-producing cells in the pancreas, Dr. Cohen says.

“Body type, food preference and genetics all play a role in determining whether an individual moves from a state of being totally normal to diabetes,” says Dr. Wayman Cheatham, assistant vice president and medical director of the MedStar Clinical Research Centers of MedStar Research Institute in Southeast.

Each year, 10 percent to 11 percent of prediabetics develop diabetes, says Dr. Mariama Semega-Janneh, assistant professor of medicine at Howard University Hospital in Northwest.

“Prediabetes is on a continuum with diabetes,” Dr. Semega-Janneh says.

The most significant risk factor for developing type 2 diabetes is obesity, followed by a sedentary lifestyle, a family history of diabetes, excessive abdominal fat, and factors of age (over 45) and race, Dr. Cohen says. The Centers for Disease and Control and Prevention in Atlanta says that in the United States, diabetes is most prevalent (in descending order) among American Indians, blacks and Hispanics.

“Fat causes the cells to be resistant to insulin,” says Dr. Thomas Donner, associate professor of medicine and director of the University of Maryland Joslin Diabetes Center.

Insulin allows sugar in the blood to enter cells and be burned as energy, Dr. Donner says.

“In the initial stages of insulin resistance, the body compensates by making more insulin,” Dr. Cohen says, adding that over time, insulin production cannot keep up, causing blood sugar levels to rise.

Diabetes and prediabetes are diagnosed with a fasting blood glucose (or sugar) test that follows eight hours of fasting or with an oral glucose tolerance test that measures blood sugar levels before and two hours after drinking 8 ounces of a sugary liquid, as stated on the Web site for the Mayo Clinic at www.mayoclinic.com/health/prediabetes.

In the first test, a blood sugar concentration of 100 to 125 milligrams of glucose per deciliter of blood (mg/dL) is considered prediabetic and anything above 126 mg/dL, diabetic, the Mayo Clinic’s Web site says. The second test measures prediabetes at 140-199 mg/dL and diabetes as anything above 200 mg/dL, the Web site says.

“The reason the number 126 is important, that is the breakpoint when you begin to damage small blood vessels. The glucose is toxic,” says Dr. Larry Deeb, president of medicine and science for the ADA. “It damages the walls inside the capillary and makes it leaky.”

Diabetes can cause several complications, including damage to the nerves, the eyes, the kidneys and the cardiovascular system, along with symptoms of excessive thirst, frequent urination, fatigue and weight gain or loss, Dr. Donner says.

An excess of glucose can react biochemically with the body’s organs and blood vessels, says David F. Williamson, senior biomedical research scientist at the diabetes division of the Centers for Disease Control (CDC) in Atlanta.

“Diabetes is blood sugar toxicity,” says Mr. Williamson, who holds a doctorate in nutritional epidemiology.

The ADA recommends that adults be screened for diabetes every three years beginning at age 45.

“The biggest finding is that prevention is always more effective and often easier than treatment,” says Dr. Stephen Clement, associate professor and acting chief of the division of endocrinology at George Washington University Hospital. “Once a person is diagnosed , even with weight loss and a changed lifestyle, studies show there is still some damage to the pancreas and to insulin production.”

The Diabetes Prevention Program, which was conducted from 1996 to 2001 by the National Institutes of Health in Bethesda, found that 30 minutes of moderate physical activity five days a week, coupled with a 5 percent to 10 percent loss of body weight, produced a 58-percent reduction in the progression of diabetes, the ADA says.

“It’s important you get yourself enrolled in a good weight-loss and weight-management program based on sustained behavior changes,” Mr. Williamson says.

The Inova Diabetes Center at Inova Alexandria Hospital, for example, offers a program for prediabetics and those at risk for developing diabetes. Participants learn how to use the blood-glucose monitor, which is a finger-stick test used by diabetics to measure glucose levels, and are encouraged to use it during the duration of the program every morning and two hours after each meal.

“People will see a difference in blood sugar depending on the volume and type of food they eat,” says Amy Morel L’Horset, diabetes nutrition educator at the diabetes center.

The participants are encouraged to eat a reduced-calorie diet moderate in carbohydrates, fats and proteins and to exercise 30 minutes a day.

“We help them get started. It doesn’t have to be all at the same time,” Mrs. Morel L’Horset says.

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