Prediabetes: How to stop progression to diabetes

Prediabetes: How to stop progression to diabetes

Gaining control of diabetes can be overwhelming. Trying to figure out how to eat, dealing with side effects of medications, and learning how to use a glucose meter is a lot to deal with. One question many people ask themselves is how did I get here? Could I have done something to prevent this diagnosis? 

Prediabetes affected 96 million adults in 2019 and continues to be on the rise.¹ With 1.2% of the world at risk, the common factors we see that contribute to diabetes are those who don’t exercise, are a high-risk race or ethnicity (African American, Hispanic/Latino, Asian-American etc.), have a first-degree relative with a history of diabetes (sibling or parent) and are overweight (BMI ≥ 25 kg/m²). A diagnosis of prediabetes primarily comes from an elevated hemoglobin A1C (HbA1c).

 When HbA1c is between 5.7-6.4% or a fasting plasma glucose (FPG) range is from 100 to 125 mg/dL, the body chemistry is off. It’s our body’s way of telling us that the insulin in our cells is becoming deficient or that our cells just aren’t responding to the insulin that is made.  Either way, we need help. Individuals with additional diabetic risk factors including obesity or family history require more attention and stricter lifestyle modifications.³

When diagnosed with prediabetes, lifestyle modifications become the mainstay of treatment. These modifications include weight loss, exercise, change in diet, smoking cessation, and even the help of natural supplementation. 80% of people are confused about healthy habits and lifestyle modifications or simply don’t know where to start.² Developing and understanding these habits and lifestyle changes for diabetes prevention may be the key to regaining control. While traditional medications do their job, it may be these modifications and healthy habits that prevent us from progression to a diagnosis of diabetes.  

Weight Loss

Losing weight is a topic most people think a lot about. The art of balancing a good diet and “moving more” is a struggle for many people.  For diabetes prevention, guidelines  encourage individuals to lose > 5-10% of their body weight. Even a 10-15lb weight loss can help improve insulin resistance in those with prediabetes.⁶ The Diabetes Prevention Program Research Group trial showed that those in a Diabetic Prevention Program (DPP) that included weight loss resources reduced the incidence of diabetes by 58% compared to 31% by those using traditional medicine only.⁷ So how do we tackle this? Exercise, a healthy diet, hydration (minimum of approximately 1600 mL/day for adults⁸), learning how to read/understand nutrition labels, sleep hygiene, and even stress management are all considered when talking about weight loss. If you’re interested in more information about this topic, refer to the “Weight Loss: A Holistic Approach” blog post.

Exercise

It’s no secret that our bodies are an exact representation of our overall well-being. Even though most people would agree some form of daily exercise is healthy and prolongs life, this is one of those things where “knowing and doing” are two different things. Adults at high risk for developing diabetes are encouraged to adopt 30-60 minutes of exercise at least three days a week, totaling about 150 minutes per week or more. This includes weight training, aerobic training, walking, etc.³ It’s also important to reduce sedentary (long hours of sitting) behaviors by standing or taking a walk every 30 minutes. Any of these options improves muscle mechanics, muscle insulin sensitivity, and increases glucose disposal.⁹ 

Smoking Cessation

Smoking increases the risk of developing diabetes. Smoking may impair insulin sensitivity and has shown proportionality to weight gain. Studies show that the number of packs per day correlates to a significant increase in blood glucose and amount of inflammation seen throughout the body.¹⁰ One study showed that people who smoked demonstrated an increased risk of developing diabetes than non-smokers. Results also showed that 26.7% of smokers who had impaired glucose tolerance reversed to normal glucose tolerance after they quit smoking.¹⁰ So, it’s a simple answer with a not so simple process. A few tips to quit smoking include recognizing your triggers, trying over the counter smoking cessation products, or seeking the help from your medical provider. 

Supplements

Natural products can be used for diabetes prevention with careful consideration and research. An individual with prediabetes may consider supplements that contain chromium, vitamin C, or berberine. Taking a product to supplement chromium may be necessary if you are deficient as chromium deficiency can lead to high blood sugar levels.¹⁰ Berberine is an extract from barberry that helps to regulate blood glucose levels.¹¹ If you’d like to learn more about natural products for glucose regulations you can check out our previous post, Preventing & Reversing Insulin Resistance Using Functional Medicine.

Nutrition

A healthy and balanced diet is probably one of the most important modifications in a prediabetic’s journey. It could mean the difference between reversing high blood sugar and developing diabetes in the future. These dietary changes include an increase in fiber, lean protein, and healthy fats as well as reducing sodium intake, natural carbohydrates and sugars. 

Proteins alone generally do not impact glucose levels directly. Protein supplies the body with amino acids and energy if carbohydrates are not available to do the job. Healthy fats, when consumed in moderation, have a minimal effect on glucose levels. Carbohydrates are the body’s main source of energy. When eaten in combination with foods high in fiber, digestion is slow and steady compared to when carbohydrates are eaten alone.  Why does this matter? The combination of fiber and carbohydrates helps slow down the digestion of carbohydrates, which can delay the absorption of glucose into the bloodstream. This results in what we call a low glycemic response.¹³ This is important because it keeps the body’s glucose levels steady and stable, reducing the risk of diabetes. 

As you can see, there is a lot you can do to prevent the progression of prediabetes to diabetes.  This topic is something we see come up with our patients on a regular basis.  Because of that, we decided to create a year-long program focusing on weight loss and blood sugar regulation.  We will be opening our sign-ups soon or the program soon, so be sure to follow us on our social platforms so you don’t miss out!  

Instagram: @pharmtotableteam

Facebook: PharmToTable Team

Written by, Jasmine Holland, PharmD Candidate

Edited by Lindsey Dalton, PharmD

References

1. Centers for Disease Control and Prevention. (2022, September 30). Prevalence of prediabetes among adults. Centers for Disease Control and Prevention. Retrieved April 23, 2023, from https://www.cdc.gov/diabetes/data/statistics-report/prevalence-of-prediabetes.html 
2. Centers for Disease Control and Prevention. (2022, September 30). Prevent type 2 diabetes. Centers for Disease Control and Prevention. Retrieved April 23, 2023, from https://www.cdc.gov/diabetes/prevent-type-2/index.html 
3. Robertson, P. R. (n.d.). Prevention of type 2 diabetes mellitus. WWW. Retrieved April 23, 2023, from https://www-uptodate-com.lecomlrc.lecom.edu/contents/prevention-of-type-2-diabetes-mellitus?search=prediabetes+and+diabetes+prevention&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1 
4. Centers for Disease Control and Prevention. (2022, November 3). Prevent diabetes complications. Centers for Disease Control and Prevention. Retrieved April 23, 2023, from https://www.cdc.gov/diabetes/managing/problems.html#:~:text=Common%20diabetes%20health%20complications%20include,how%20to%20improve%20overall%20health.&text=How%20to%20be%20heart%2Dhealthy%20if%20you%20have%20diabetes. 
5. Healthy Weight. Centers for Disease Control and Prevention. https://www.cdc.gov/healthyweight/index.html. Published 2021. 
6. Franz MJ. Weight Management: Obesity to Diabetes. Diabetes Spectr. 2017 Aug;30(3):149-153. doi: 10.2337/ds17-0011. PMID: 28848305; PMCID: PMC5556579.
7. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM; Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002 Feb 7;346(6):393-403. doi: 10.1056/NEJMoa012512. PMID: 11832527; PMCID: PMC1370926.
8. Sterns, R. H. (n.d.). Maintenance and replacement fluid therapy in adults . WWW. Retrieved April 28, 2023, from https://www-uptodate-com.lecomlrc.lecom.edu/contents/maintenance-and-replacement-fluid-therapy-in-adults?search=daily+water+intake&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1 
9. Riddell, M. C. (n.d.). Exercise guidance in adults with diabetes mellitus. WWW. Retrieved April 23, 2023, from https://www-uptodate-com.lecomlrc.lecom.edu/contents/exercise-guidance-in-adults-with-diabetes-mellitus?search=prediabetes+and+diabetes+prevention&topicRef=1774&source=see_link 
10. Robertson, P. R. (n.d.). Type 2 diabetes mellitus: Prevalence and risk factors. WWW. Retrieved April 23, 2023, from https://www-uptodate-com.lecomlrc.lecom.edu/contents/type-2-diabetes-mellitus-prevalence-and-risk-factors?sectionName=Smoking&search=prediabetes+and+diabetes+prevention&topicRef=1774&anchor=H10&source=see_link#H10 
11. Vitamins & diabetes. Vitamins & Diabetes | ADA. (n.d.). Retrieved April 24, 2023, from https://diabetes.org/healthy-living/recipes-nutrition/vitamins-diabetes 
12. Naturally manage diabetes and lower A1C levels. GlucoRedi. (n.d.). Retrieved April 24, 2023, from https://www.glucoredi.com/#ingredients_section 
13. Carbs, protein and fats – their effect on glucose levels. Joslin Diabetes Center. (2023, March 24). Retrieved April 28, 2023, from https://www.joslin.org/patient-care/diabetes-education/diabetes-learning-center/carbs-protein-and-fats-their-effect#:~:text=Because%20the%20combination%20of%20fiber,in%20glucose%20levels%20after%20eating.