Prediabetes Management: A golden opportunity to reverse course

Chances are high you know someone who has diabetes. In 2024, more than 38 million Americans, or 11.6 percent of the U.S. population, had diabetes. An additional 98 million Americans have prediabetes, more than one in three. Let that sink in: more than one in three! Most people with prediabetes don’t know they have it and if current trends continue, the prevalence of diabetes is projected to continue to increase. (Figures from the Centers for Medicare and Medicaid Services).

People who are born with or develop diabetes can be any age, weight, race, gender and in any type of health. Types of diabetes include both auto-immune, typically considered Type 1, and that caused by insulin resistance, Type 2.

Diabetes mellitus, the technical name for diabetes, is a group of diseases occurring when the body’s insulin production can’t keep pace with its needs, either because the pancreas is damaged and can no longer make insulin or because the body doesn’t properly use the insulin that is present (resistance). Sometimes, it’s a combination of both. Either way, without enough insulin, the body can’t get glucose from the blood into the cells, leading to high blood sugar levels.

Type 1 diabetes, classically considered juvenile diabetes, afflicts at least five percent of people with diabetes. There are both genetic and environmental causes for Type 1 diabetes, such as growing causal relationship evidence with coxsackievirus B, but lifestyle factors aren’t thought to play a significant role. Insulin therapy is required for this type of diabetes.

Type 2 diabetes starts as insulin resistance, meaning the body cannot use insulin effectively. When this happens, it stimulates the pancreas to produce more insulin until it can no longer keep up with demand. That leads to high blood sugars. The exact cause of insulin resistance and Type 2 diabetes is complex but an elevated body weight, due to caloric imbalance, is the primary risk factor. The incidence of type 2 diabetes is rising dramatically. In the past decade, the prevalence of type 2 diabetes has increased by 157 percent, according to the Colorado Department of Public Health and Environment.

Prediabetes is really a golden opportunity. It’s a condition occurring prior to the formal onset of Type 2 diabetes. It means that blood sugar levels are higher than normal, but not yet high enough to be diagnosed as a Type 2 diabetes, a threshold defined based on the likelihood of experiencing complications of diabetes later in life. Having prediabetes does not make Type 2 diabetes inevitable. With aggressive lifestyle changes including healthy eating, exercise, weight loss, and possibly medications, it’s possible to bring slightly higher blood sugar levels back into normal ranges. Prediabetes is reversible!

In the past five years, the Centers for Medicaid and Medicare have acknowledged the significant results achieved when prediabetic individuals had access to programs aimed at affecting the lifestyle changes necessary to get their blood glucose levels back into a normal range. Halting the progression of Type 2 diabetes has the potential to save billions of dollars a year in diabetes-related healthcare costs. It is estimated that in 2022, the US spent $412 billion on direct medical costs for diabetes and $106 billion in indirect costs. Without lifestyle changes, prediabetes poses a big risk of progressing to Type 2 diabetes within ten years. Fortunately, there are approaches that address the lifestyle changes necessary to prevent prediabetic individuals from crossing that threshold into a Type 2 diabetes diagnosis. Valley View encourages all patients to have a relationship with a primary care provider (vvh.org/services/primary-care) to evaluate risk and recommend standardized programming and/or medication management, when indicated.

Rob Nelson is a certified physician assistant and board-certified in Advanced Diabetes Management. He serves as the clinical supervisor of Valley View’s Health4Life diabetes programs. He sees patients in clinic at Internal Medicine at Valley View, including services for continuous glucose monitoring and insulin pumps. For more information, visit vvh.org/internal-medicine or call 970.384.6707.