Transcription:
All About Prediabetes

Melanie Cole (Host): Prediabetes is a serious health condition where blood sugar levels are higher than normal but not high enough yet to be considered type 2 diabetes. My guest to explain this to us today is Dr. Chrisoula Kiriazis. She’s the Medical Director for the diabetes prevention at BayCare Health. Dr. Kiriazis tell us what is diabetes and what is the difference between diabetes and prediabetes?

Chrisoula Kiriazis, MD (Guest): Okay, well diabetes is a condition of elevated blood sugar associated with – that cause us to have increased risk of heart disease, kidney disease, nerve damage, blindness, dialysis. So, most of us know about diabetes. We know it’s a horrible disease. We have relatives who have suffered with diabetes, given themselves insulin injections, taken lots of medications for this condition that is progressive and damaging in all sorts of ways.

Prediabetes is the condition that leads to diabetes. So, when your blood sugar is higher than normal, but not high enough to meet a diagnosis of diabetes; you are considered prediabetic. One in three adults in America are prediabetic and only about a third of those people realize they are prediabetic. So, prediabetes may not sound like a terrible diagnosis because you say well I don’t have diabetes so, why should I worry about this. but you should worry about this because prediabetes elevates your risk of having a heart attack even before you are diabetic, and prediabetes damages your nerves. So, you can develop for example, neuropathy of the feet after having very minimal elevations of blood sugar for many years.

So, the truth is, when you have prediabetes; you need to look at it and say this is a warning, this is an indication that something is wrong in my body. It’s typically related to insulin levels that are too high and often driven by weights that are too high. So, that’s your message to say okay, I need to treat this because prediabetes is a curable condition. And the cure is really lifestyle related. We do have medication for prediabetes, but truly we want people to focus on lifestyle change as a means of resolving this condition before they become diabetic.

Melanie: So, that’s a perfect segue into this next question. If you have been told that you have prediabetes, the first line of defense doctor, would be what? Do you look to exercise right away, weight loss or certain foods that you are eating? Because I know that people get confused about the foods and specifically carbohydrates, they don’t know a good carbohydrate from a bad carbohydrate. So, where do they start in those lifestyle changes?

Dr. Kiriazis: Nutrition information is really confusing. So, let me talk first about exercise. So, certainly exercise improves blood sugar by reducing our body’s resistance to insulin. So, when we exercise, our body is able to take up blood glucose more effectively, because our insulin levels go down. So, exercise is a wonderful adjunct and a wonderful part of treatment of prediabetes, but exercise alone often does not resolve this problem. So, dietary change and weight loss are really the key for most people. Now if you said what kind of diet must I follow? We focus on reducing refined carbohydrates in the diet; so avoiding sugary drinks, avoiding white bread and pasta and rice and desserts, snack foods and also reducing the amount of animal protein in the diets because of course, fat carries a lot of calories and even though red meat for example, isn’t a carbohydrate; if you eat lots of red meat which has a lot of calories in it, then you will be more likely overweight and if you are overweight, regardless of how you got there. Whether you got there by eating a lot of carbohydrates or by eating a lot of saturated fat; your body is going to become resistant to insulin. So, when we eat too much, whatever it is that we eat, then our insulin levels are higher and that is what drives diabetes. So, while what is currently in style is a ketogenic diet, which means avoiding all kinds of carbohydrates; truly, any diet that allows you to lose weight will improve your blood sugar.

Melanie: That’s really a very good point. So, how often should somebody who has been told that they are prediabetic check their blood sugar?

Dr. Kiriazis: Well, interestingly even when you have diabetes, if you have type 2 diabetes and you are not taking insulin; the research does not show that checking your blood sugar actually improves your outcome. So, that’s interesting, right, because you think well how does that possibly make any sense? How should you not be checking your blood sugar if you are a type 2 diabetic who is not on insulin? How would you know what to do?

So, that’s the research results that you shouldn’t check your blood sugar if you are a type 2 diabetic who is not on insulin. But the truth is, checking blood sugar really helps people. It helps people to understand well what is the effect of their diet on their blood sugar and it helps them to modify their behavior.

If you are a prediabetic, you don’t really have to check your blood sugar. It’s not much fun to poke your finger and so, what I tell people is more important than your blood sugar, monitor your weight. Because weight and blood sugar are very closely linked and it’s a lot easier to get on a scale than to poke your finger.

Melanie: Certainly, that’s true now tell us about the BayCare treatments to speak about the prediabetes workshop that you offer.

Dr. Kiriazis: Okay, so, we have a nutrition department really with excellent well-trained nutritionists and diabetic educators and they provide a three-hour workshop for people who are prediabetic. This workshop is offered at no cost to everybody regardless of their insurance. So, this is huge benefit because it allows people to develop some information and some familiarity with this diagnosis. What is it? What do I really – what does it mean for me? What do I really need to do? How can I start to do it? So, our prediabetes workshop, is a great starting point for people to start to understand this diagnosis and start to make steps to change, to improve.

Melanie: Dr. Kiriazis the CDC created the yearlong prevention program. Tell us a little bit about that, how it’s at the Winter Haven Hospital and local YMCAs.

Dr. Kiriazis: So, the National Institute of Health did studies going back to the 1990s looking at treating prediabetes. So, they did a study looking at giving people medication and then doing intensive lifestyle changes meaning helping people to change their diets dramatically and exercise regularly. So, the results were very dramatic. It showed that lifestyle change improved – resolved prediabetes by 58% and almost twice as much as medication alone. So, truly, the power is – we have the power as far as helping people to change their lifestyle to resolving this problem.

So, based on those studies, the CDC developed a yearlong diabetes prevention program. Over the last 20 years, this program has been disseminated throughout the country and is run by a variety of places. Here in BayCare, we have Winter Haven Hospital who runs this program and every YMCA in our community runs this program. It is so successful because it’s proven to have results. And so, over time, the insurers have figured this out that this program really works, and we are going to pay for it. So, not really quickly but gradually, we have had increasing reimbursement by the insurers which is a huge game changer for people because it allows them to attend this program at no charge and allows them to be part of a one-year small group where they meet weekly for 16 weeks and then biweekly and then finally monthly for a whole year. They meet and also exercise with the goal of achieving 150 minutes of exercise per week. So, they do this for a year and the goal is for patients to lose five to seven percent of their body weight. But often I have had patients lose more than that. So, if you commit to doing something like the YMCA diabetes prevention program or the Winter Haven program; really essentially the same program just offered at different places; you are likely to be successful and resolve prediabetes. And while it may seem that a commitment for a year is just overwhelming; but we know that it takes 16 weeks to really embed lifestyle change in someone’s practice, right. We need to commit to a certain amount of time to allow us to change our eating habits and to start to do things differently. So, it really is the way to go.

The prediabetes workshop is kind of a flavor of what you should be doing, but the YMCA and the Winter Haven programs are primetime. This is your opportunity to make a change. It’s accessible. Available at all the YMCAs. They work very hard. So, Summer Crup who runs the program for us works very hard to get people to a program that meets their community needs, close to their home, at the right time. So, we want to spread the message that this program is available, that it is accessible. A lot of the insurers cover it. If the insurers don’t cover it; we have assistance programs available. So, we would like to increase utilization of this program.

Melanie: Wrap it up for us doctor, with your best advice. If somebody has been given the news that they have prediabetes; what do you want them to know? The most important best advice if they have been given that news?

Dr. Kiriazis: What I’d like to tell people is they should take action now. Prediabetes is a serious condition and preventing diabetes will really improve the quality and longevity of their life. Going to the prediabetes workshop is a great starting point but going further than that, attending the YMCA program either at Winter Haven Hospital or at a local YMCA is really a life changing experience and is something that we would like all prediabetics to do.

Melanie: Thank you so much doctor for joining us and sharing your expertise and explaining the difference between full blown diabetes and prediabetes and how this is something that really can be fixed if you take action as you say, so, thank you again for joining us. You’re listening to BayCare HealthChat. For more information please visit www.baycare.org, that’s www.baycare.org. This is Melanie Cole. Thanks so much for listening.