The guy I saw the other day was there with a twisted ankle. “So” he asked, “why did the nurse need to ask me about my blood pressure and if there’s diabetes in the family?”
It didn’t have much to do with his ankle it’s true, but what he didn’t know is that at the Moss Clinic we’re running a program to screen for a serious medical problem that affects a third of the population. But of that third, nine out of ten people don’t know they’ve got it.
The Problem
What we’re screening for is pre-diabetes - where fasting blood glucose is elevated, in the 100 to 125 mg/dl range (it shouldn’t be more than 99 mg/dl - and above 125 mg/dl is in the full blown diabetes range)
I tell my patients “don’t get diabetes” – this because the toxic effects of elevated glucose, and the oxidative stress it causes is so widespread and pernicious. It causes damage to large and small blood vessels resulting in neuropathy (painful inflammation of the nerves), nephropathy (damage to the kidney) coronary artery and generalized vascular disease – resulting in heart attacks and heart failure, and poor circulation to the feet in particular (it is the commonest cause of foot amputation). It also effects the eyes and is a common cause of acquired blindness.
So detecting it and “nipping it in the bud” is a good thing.
Unfortunately, we are becoming less active and eating more processed and fast foods, which promotes diabetes and obesity.
Instigated by Natalia Giscombe-Simons as part of a nursing doctorate program she is doing at VCU, and partly funded by a grant from Virginia Diabetes Council, Moss Clinic is doing a trial of a questionnaire based on the American Diabetes Association Risk Test. This asks about history of blood pressure, family history of diabetes, amount of exercise as well as ethnicity, sex and weight to identify people at risk.
Anyone scoring a 5 or more has their Hemoglobin A1c measured (an indicator of what the blood sugar has averaged over the preceding 90 days or so). Above 5.7% is pre-diabetic (full-blown diabetes is above 6.4%).
The Challenge
These at risk pre-diabetics need to change their diet and lifestyle. A challenge that is taken on by YMCA explained Associate Community Health Director for the Fredericksburg branch, Nicole McGee. They run courses with classes consisting of 25 sessions run over a whole year. “People really benefit from being in a group and learning from each other” noted McGee.
People do find this a bit daunting though, one of the teachers, certified Life-style coach Zakia Wichowki told me. But they “are motivated by concern about developing full -blown diabetes.”
She is motivated to teach others, Wichowki told me, being diabetic herself - though she presumably practices what she preaches, as she told me “I’ve had no diabetes in the last 15 years.”
Despite pre-diabetes being so common, people are still surprised and upset when they are diagnosed, she told me. And still find it hard “to give up their favorite foods like cheesy fries” - which she seems to see as the epitome of what you shouldn’t eat.
They also tend to feel ashamed, and uncomfortable about coming to a gym. “They’d much rather just take a pill” she told me.
Smart But Simple
This is a work in progress to an extent, but the United States Preventive Services Task Force (USPSTF) – that expert panel that advises on what interventions are worthwhile - recommends screening all adults between 35 and 70 years for pre-diabetes – especially anyone overweight.
In the US with its runaway development of ever more high-tech, expensive, interventions, it’s gratifying to see a common-sense, low tech, highly effective – but unfortunately not particularly sexy – program, that has huge potential benefit to shine the light on this very common and potentially very serious problem.
