Is this putting your child at risk later in life?

Type 2 prediabetes is a health condition in which blood sugar levels are higher than normal, but not quite high enough to be yet considered type 2 diabetes. The danger with prediabetes is that it is a pre-curser condition that can lead to actual diabetes if lifestyle changes are not made.

That makes the recent Center for Disease Control and Prevention press release about prediabetes and young people incredibly alarming. The release reveals that nearly one in five adolescents ages 12 to 18 years old and nearly one in four young adults ages 19 to 24 have prediabetes.

“It’s because of obesity,” said endocrinologist Mary Crowell, MD, of the Endocrine Center of Cape Cod. “For so many years our concern has been about type 1 diabetes, a chronic condition in which the pancreas produces little or no insulin. That’s the form of diabetes we see in kids. But over the past 10 to 20 years, unfortunately, there has been the epidemic of childhood obesity, and now we’re starting to see type 2 diabetes in kids. It’s kind of terrifying.”

Dr. Crowell explained that diabetes is not the only issue that worries her. Diabetes often goes hand in hand with high cholesterol, high blood pressure and a visceral or abdominal obesity and all of those things are huge risk factors for cardiovascular disease.

“Of course, diabetes is a big deal, but what does this mean for the whole generation of kids as they age into adulthood? They’re going to be seeing significant cardiovascular morbidity far earlier because this metabolic problem is happening so young,” she said.

You don’t actually have to have diabetes for risks to increase dramatically. Even the lower degree of hyperglycemia of prediabetes causes an increased rate of heart attacks, strokes and cardiac death.

There is Hope

As dire as that sounds, there is hope that, with lifestyle changes, people of any age can reverse the effects and eliminate the disease. The CDC has a National Diabetes Prevention Program that is run at YMCAs across America, including the one in Barnstable. The program is open to adults age 18 or older. It is taught by trained lifestyle coaches and encourages healthy life changes such as improved nutrition, increased physical activity and coping mechanisms for stress reduction.

According to the CDC, research shows that the program really works. Adults with prediabetes can cut their risk of developing type 2 diabetes by 58 percent. Those over the age of 60 can cut their risk by 71 percent. There is no reason to believe that these lifestyle changes wouldn’t be just as effective with teenagers, Dr. Crowell said.

The National Diabetes Prevention Program (DPP) was developed from a large groundbreaking study of the same name that came out in 2002. The goal of the study was to determine whether the 3,234 participants with prediabetes could prevent or delay the onset of Type 2 diabetes with lifestyle or medication.

DPP participants were randomly assigned to one of three groups:

• Lifestyle Change Group: These participants participated in what was basically a lifestyle boot camp. Participants tried to lose seven percent of their body weight through a diet with less fat and fewer calories and get at least 150 minutes of exercise a week.
• Metformin Group: These participants took 850 milligrams of the diabetes medication metformin twice a day and were provided standard advice about diet and exercise.
• Placebo Group: These participants took a placebo twice a day and were provided standard advice about diet and exercise.

The participants were followed for three years. The placebo group progressed to diabetes at a rate of about 11 percent a year, which meant that, in that short term, about one-third of them developed diabetes. The metformin group reduced their risk of progressing by about 30 percent. But the big news was with the lifestyle change group. They reduced their risk by close to 60 percent.

“That’s almost twice as good as the metformin group,” Dr. Crowell said. “I tell folks that losing seven percent of their body weight isn’t that difficult and doing so will reduce the risk by almost 60 percent. Meds are great, but lifestyle changes are the best and most effective way to lower their risk.”

You Can Control Your Health

When Dr. Crowell tells patients they have prediabetes, they generally give her a look of terror. But she explains to them that it is not a done deal. They can take control of their health and change the outcome.

“It’s scary, but it’s empowering,” she said. “If you know this, you can really change the trajectory of your health over the long term.”

The CDC offers these suggestions to prevent prediabetes from becoming type 2 diabetes:

• Maintain a healthy BMI by eating a nutrient rich diet of fruits, vegetables and grains with minimum fat and sugar.
• If you are overweight, lose seven percent of your body weight.
• Exercise at least 150 minutes a week if you are an adult and at least an hour a day if you are a child or teen.
• Don’t smoke.
• Keep your cholesterol levels low.
• If you have high blood pressure, take medication for it.

The CDC also has a prediabetes risk assessment test online.

If all of those changes seem overwhelming, Dr. Crowell recommends starting slowly.

“If 30 minutes of exercise a day sounds overwhelming, just start somewhere,” she said. “Even if you can commit to 30 minutes once or twice a week, we do believe improvement is incremental so even a little bit counts. Any little bit of lifestyle change you can make is going to make a difference and lower your risk so it’s worth doing anything you can.

When it comes to diet, a good place to start is by cutting out the white foods: white bread, white flour, white rice, white sugar. A weight-loss program like Weight Watchers can also help.

“When it comes to weight loss, there are three things we think about,” Dr. Crowell said. “One is exercise – 150 minutes a week. One is making dietary changes that are healthier. But the third part is behavior modification.”

With behavior modification, patients have to figure out what their food triggers are so they can avoid them. Do you eat when you are bored? Do you eat when you are anxious? Once you identify what causes you to eat too much or to eat the wrong foods, it is easier to change it and find people to help.

Some patients with prediabetes have to take medication and make lifestyle changes, but the medication doesn’t have to be permanent, even with a diagnosis of type 2 diabetes. Making the right lifestyle changes can literally reverse the course of the disease.

“We stop medications all the time, which is fantastic,” Dr. Crowell said. “I always do a happy dance when I do that for my patients.”