The Centers for Disease Control and Prevention (CDC) released a shocking statistic a few weeks ago: Eighty-nine percent of the 79 million Americans with pre-diabetes are not even aware they have the condition. In other words, there are 70.3 million Americans over the age of 20 at high risk for developing type 2 diabetes at any moment … and they don't even know it.
This is troubling for several reasons. For starters, type 2 diabetes is a chronic condition associated with a reduced life expectancy; the average 50 year old with diabetes loses an estimated 8 1/2 years of longevity. Prevention, therefore, translates into increased likelihood of a substantially longer life—the end of which is less likely to be spent shuttling to and from doctor's offices and hospitals. Secondly, there are several established ways to delay—if not entirely prevent—the onset of diabetes in people with prediabetes.
But unless you know you're at risk, it's unlikely you'll stumble upon these preventive measures in time to halt the progression toward full-fledged diabetes. In any given year, about 11 percent of people with prediabetes "graduate" to developing type 2 diabetes.
Prediabetes is a condition in which your ability to handle blood sugar is impaired, but not so impaired as to qualify for full-blown diabetes. It results from reduced sensitivity to the hormone insulin, which helps carry glucose from the blood into cells where it can be used for energy.
(It's important to mention that prediabetes and type 2 diabetes are acquired metabolic conditions. Type 2 diabetes represents about 95 percent of diabetes cases nationwide. It differs in both cause and treatment from type 1 diabetes, an autoimmune condition that generally strikes during childhood and results in destruction of the insulin-producing cells in the pancreas. Type 1 diabetes is not known to be preventable through diet or lifestyle measures.)
Importantly, pre-diabetes is reversible; glucose tolerance can improve when a person's metabolic state of affairs improves. Here's how:
• Very moderate exercise. You don't need to spend hours every day sweating up a storm in a spin class to reap the diabetes-preventing effects of exercise. Heck, you don't even need to join a gym. Research suggests that 2 1/2 hours per week of even leisurely physical activity—like brisk walking—is enough to significantly improve glucose tolerance. This translates into a 30-minute walk five times per week—though of course, if you're up to the challenge, more is even better. Exercise works because muscles in action are able to take up glucose from the blood without the help of insulin, so get moving!
• Very modest weight loss. Evidence suggests that it only takes about a 5 to 7 percent weight loss to delay by several years the onset of diabetes among overweight people with prediabetes. To put that in perspective, a 5-foot-4-inch woman with pre-diabetes who weighs 160 pounds would only need to lose about 11 pounds to reduce her risk of developing diabetes. A five-foot-11-inch man weighing 220 pounds would need to lose about 15 pounds to hit this target. In other words, one doesn't have to drop dramatic, "The Biggest Loser"-scale amounts of weight to help protect against diabetes. In some people, small lifestyle changes like avoiding sweetened beverages or decreasing carb portions may be sufficient to promote this degree of weight loss.
In fact, research has shown that modest weight loss, coupled with 150 minutes of weekly exercise, reduced by 58 percent the risk of developing diabetes in a population of obese adults with prediabetes. Specifically, participants who started off weighing an average of 207 pounds lost about 12 pounds (or 5.7 percent of their body weight). Notably, this outcome was substantially more effective than using an insulin-sensitizing drug called metformin in preventing the onset of diabetes.
• Curcumin supplements. Recent research out of Thailand that was published in Diabetes Care suggested that supplementing curcumin—the active ingredient in the bright yellow, anti-inflammatory spice turmeric—may be protective against diabetes among people with pre-diabetes.
Although it was only a single, small study (237 people), it was well designed and showed a very promising clinical benefit: Of the group randomly assigned to take 500 milligrams of curcumin supplements three times daily, none progressed to develop type 2 diabetes after nine months. By way of comparison, 16 percent of participants in the placebo group did develop type 2 diabetes in the same time period.
Since the research population was homogeneously Asian, it's not clear whether these results can be extrapolated to a general American population. And since the study was short, it's unclear whether the protective benefit would have extended past the nine months studied. Nonetheless, given how inexpensive and well-tolerated this natural supplement tends to be, it may be worth talking with your doctor or dietitian to see if curcumin is an appropriate supplement for you to consider.
With 70 million of us counted among the unknowing ranks of adults with pre-diabetes, it's statistically likely that you or someone you know belongs to this group. Risk factors for pre-diabetes include being overweight or obese; having a family history of diabetes; having a personal history of gestational diabetes in pregnancy; having given birth to a baby weighing more than nine pounds; and belonging to one of several ethnic groups, including African American, Hispanic, Asian American, Pacific Islander or Native American. If you fall into one of these categories, consider making an appointment for a check-up; prediabetes can be assessed with simple blood tests from your primary care doctor.
Knowing your status could make a huge difference in turning the tide against progression to diabetes before it's too late.
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Clarified on 04/09/2013: A previous version of this article failed to make clear that it specifically addresses type 2 diabetes.
Tamara Duker Freuman, MS, RD, CDN, is a NYC-based registered dietitian whose clinical practice specializes in digestive disorders, Celiac Disease, and food intolerances. Her personal blog, www.tamaraduker.com, focuses on healthy eating and gluten-free living.