Losers can be winners: Reducing excess weight may reverse prediabetes

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It comes as no surprise to ACSH staffers that the newest CDC statistics indicate that prediabetes is on the rise in the U.S. One obvious reason is that more and more Americans are becoming overweight or obese. The number of adults with prediabetes rose from 57 million in 2008 to 79 million in 2010 while full-on diabetes (mostly Type II) increased from 23.6 million to 26 million during the same time period. However, ACSH's Dr. Gilbert Ross pointed out that to some extent, the increase is an artifact of the greatly increased use of Hemoglobin A1C — glycosylated hemoglobin — as a screening test. This test is much more sensitive for the earlier detection of blood sugar abnormalities.

While having prediabetes doesn’t guarantee the future onset of diabetes, it is a sign that the body is experiencing more difficulty maintaining healthy blood sugar levels, which is a risk factor for diabetes. “Many people have it and don’t know it,” says Dr. Kevin Kaiserman, a pediatric endocrinologist from the American Diabetes Association, who recommends better dieting and more exercise to those diagnosed with prediabetes. “Lifestyle changes can absolutely reverse the course,” he says. Supporting this recommendation is the 2002 Diabetes Prevention Program randomized study comparing 3,000 prediabetes patients who underwent treatment with the diabetes drug metformin to those receiving intense exercise and weight-loss support or a placebo. The patients receiving the exercise and weight-loss counseling had the highest reduction in diabetes risk — 58 percent compared to 31 percent on metformin. The same study also showed that 30 minutes per day of moderate physical activity and a 5 to 10 percent reduction in body weight can also reduce one’s diabetes risk.

ACSH’s Dr. Elizabeth Whelan agrees that a less caloric diet and daily exercise are important for reducing one’s diabetes risk, but she is surprised to hear that “there are doctors telling people who are only slightly overweight that they are at risk for prediabetes and need to lose that weight. In fact, several studies have shown that being slightly overweight may be linked to longer life expectancy, as compared to those who are either more overweight or obese, as well as compared to underweight people.”

Dr. Ross reminds us that “there is a difference between prediabetes and being overweight — being mildly overweight in and of itself won’t cause prediabetes.”