Transcription:
Diabetes Prevention: What You Need to Know

Scott Webb: Welcome to UK HealthCast from the University of Kentucky Healthcare. I'm Scott Webb. And today, we're discussing prediabetes with Tami Ross. She's a nationally recognized registered dietician and certified diabetes care and education specialist with UK Healthcare's Barnstable Brown Diabetes Center. She's the author of What Do I Eat Now? A Guide To Eating Well with Diabetes or Prediabetes. And she's the coordinator of UK Healthcare's National Diabetes Prevention Program.

So Tami, thanks so much for your time today. I've been looking forward to this podcast and, you know, I think a lot of us sort of at least think we know what diabetes is, type 1, type 2. But prediabetes is in and of itself kind of its own thing and we really need to talk about this, really need to educate folks. So just as we get rolling here, what is prediabetes?

Tami Ross: You know, prediabetes actually is a very common condition. And as the name implies, pre- kind of comes before type 2 diabetes, which is what many people know as adult-onset diabetes. That's what it used to be called, but now we know type 2 diabetes can occur at any age. And so prediabetes is where blood sugars are higher than normal, but they're not up into that diabetes range.

But the thing is prediabetes can cause problems if it's not managed. And so here at Barnstable Brown Diabetes Center, we have National Diabetes Prevention Program that really focuses on proven lifestyle changes that can help prevent or delay prediabetes from going on to develop into type 2 diabetes.

Scott Webb: Yeah. And you're so right, it can be prevented, it can be delayed. And so I'm just trying to think in like the place of a listener here, because I think a lot of people think, "Well, prediabetes is before diabetes, so it's maybe not so bad." And, you know, maybe there's some truth to that, but again, it is in and of itself its own thing and not a good thing because, of course, prediabetes can lead to type 2 diabetes as you've said. So how would somebody know? What are the signs and symptoms of prediabetes?

Tami Ross: Yes. So there's really no clear symptoms. And that's why it often will go undetected. So people may not, you know, have any of those symptoms that we would associate with diabetes, like increased thirst or fatigue. And so, because there's often no symptoms, it kind of flies under the radar. That's kind of how I think about it. And so when folks go in, you know, for maybe their annual blood work, get their blood work checked and find out, "Oh, you have prediabetes," what that means is their blood sugars are higher than normal, but they're not up into that diabetes range.

But, you know, I think you made a really important point that a lot of people may not take it seriously. They think, "Oh, it's not a big deal." But what I would tell our listeners is don't let that prediabetes fool you, that it actually can increase the risk for not only type 2 diabetes, but heart disease and stroke. And so I think we want listeners to know prediabetes is real and it's very common. But the important thing is it's reversible. There's over a 50% chance with the prediabetes that we can kind of turn back the clock and halt it or halt the progression on to type 2 diabetes. So, it is important.

Scott Webb: It is absolutely important. and we'll play a little true false here, Tami. Most people know someone with prediabetes, true or false?

Tami Ross: Oh, I would let our listeners think about that a moment. Most people know someone with prediabetes, the answer to that actually is true. And so when we think about it, one in three Americans have prediabetes. And kind of an interesting statistic I like to think about is, you know, when we go to the ocean, the beach, we get concerned about shark attacks. And so the risk of shark attack is one in 11.5 million chances. But the incidence of prediabetes is one in three. So people are more scared of, you know, a shark attack than prediabetes.

Scott Webb: Oh, that's such an interesting way. It's kind of a funny way to put that. You're right, we do worry so much when we go to the beach about sharks, but one in three, that's obviously, as you said, it's very common, much more common than most people probably realize. And we'll do another little true false for listeners, because I think when it comes to prediabetes and diabetes especially, folks just assume they associate it all with sugar. Too much sugar is bad, and then you get diabetes. Well, okay, so true or false, listeners and Tami, does eating too much sugar directly lead or cause prediabetes or diabetes? I wish I had the Jeopardy! thing, the Jeopardy! music, I it right here, right? It's a true or false?

Tami Ross: Right. So eating too much sugar does not cause prediabetes and diabetes. That is a myth that is out there. And, you know, I think particularly during the holidays, people are thinking about, "Oh, I've had sweet treats and maybe this caused it," but no, eating too much sugar does not cause prediabetes or type 2 diabetes.

Scott Webb: Yeah, I figured you were going to say that. And I'm hoping that listeners also said false.

Tami Ross: Right.

Scott Webb: Sugar is involved here, of course, but it doesn't directly lead to prediabetes or diabetes. And Tami, when we think about the risk factors for prediabetes, I know there's a six-question test. So I want to have you go through that and I'm going to do it along with you. I'm going to count the score on my fingers, but take us all through this.

Tami Ross: Okay. So I'm going to ask you six questions. And for each question, I'll tell you how many fingers to hold up based on your response. And then at the end of the six questions, you're going to count how many fingers in total that you're holding up and that's going to tell us your risk.

So the first question is, if you're a man, hold up one finger. If you're a woman, no fingers. The second question is related to age. So how old are you? So if you're over 60, hold up three fingers. Over 50, hold up two. Over 40, hold up one. Otherwise, zero. Okay. So our third question is related to physical activity. Are you physically active? Hold up one finger if you're not very physically active. Otherwise, zero.

Scott Webb: All right. I'm with you.

Tami Ross: Okay. Moving on to question four here. So we're going to talk about family history. Is there anyone in your family with diabetes? So if yes, hold up one finger. Otherwise, none. And our fifth question is about blood pressure. Do you have high blood pressure? Hold up one finger if yes. Otherwise, no fingers.

And lastly, what is your body type? Now, I'm going to give you four different options here. So, you want to think about kind of where your weight category is. So if your slender, zero fingers. If you're a little overweight, hold up one. If you're a good bit overweight, hold up two. And if you're a whole lot overweight, hold up three. And I know that that's kind of broad and generic, but it's just helping us to kind of get a picture of what your risk might be.

Okay. So now everybody count how many fingers you're holding up and I'm not going to ask you what yours is, but if you find you're holding up five fingers or more, you likely have prediabetes. And so those are the six questions that really can help us assess very easily.

Scott Webb: Well, Tami, I have to tell you, and I appreciate you not asking, but I am staring at five fingers. So yeah, and that's good to know. It's just good information to have. And hopefully for listeners there, hopefully they're not driving while they're doing this. Hopefully, they're stationary. Hopefully, they're not holding up five fingers, but if they are, as you say, that's just a good indication that we may have prediabetes and that's something to speak with our provider about, speak with our primary care provider about and be tested, right? As you indicated early on here today, there's testing available, right?

Tami Ross: Right. And, you know, it's simple to find out. It's just a simple blood test. Your doctor can typically check that during your annual visit or if you're going in quarterly for visits. But typically what they'll look at is a blood test called an A1c and that's a blood test that looks back at the last two to three months. So it really gives us a big picture of what your blood sugars have been running. And if you had prediabetes, that result would come back, your A1c would be in the 5.7 to 6.4 range. The other tests I look at is just your fasting blood sugar. And if that is in the 100 to 125 range, that indicates prediabetes as well. So just so listeners kind of know, that's what your doctor would be looking at to help determine, you know, if that may be present.

Scott Webb: So Tami, let's talk about UK's Diabetes Prevention Program. What is that exactly? Because it sounds pretty comprehensive.

Tami Ross: Yeah. So the diabetes prevention program, it is a proven lifestyle change program designed to prevent or delay prediabetes from going on to develop into type 2 diabetes. And so really this is a program that is nationally accredited by the CDC, the Centers for Disease Control and Prevention. And so, we have gone through rigorous criteria to be able to offer this program and what it really focuses on is losing a modest amount of weight and getting regular physical activity.

And so kind of the way I think about it is I think about prediabetes as coming to a fork in the road. If you ignore it and go to the left, your risk for type 2 diabetes goes up. But if you take the fork to the right and you lose a modest amount of weight, you get regular physical activity, then your risk goes down. And so really the Diabetes Prevention Program, it's life changing for our participants that go through this program.

Kind of how it runs is it's a 12-month program. And initially, we'll meet weekly, kind of get the core content and behavior changes started. And then the visits begin to spread out to once or twice a month. And so at UK, with our Diabetes Prevention Program, we have diabetes care and education specialists that are trained as lifestyle coaches to really facilitate this program and lead our participants to change their habits and eat healthier, be more active and lose a little bit of weight along the way. And so that's kind of in a nutshell is what the Diabetes Prevention Program is.

Scott Webb: You know, let's talk about like eligibility, how much weight someone has to lose. You know, we've touched on the weight and physical activity, but maybe we can put some numbers or percentages on that. So first, you know, is there any special or specific eligibility criteria? And when we think about that weight loss and physical activity, what are we really talking about in practical terms?

Tami Ross: Yeah. So that's a really good question. So in terms of eligibility, it's designed for adults, so 18 or older. And for women, we want women that are not pregnant because we don't want you to lose the weight when you're pregnant typically. And in terms of weight criteria, it would be for those individuals that have a body mass index of 25 or above. And most people have heard of BMI or body mass index, it's really just a measure that's based on height and weight.

And then the other criteria is the risk for prediabetes. So that could be either indicated by blood work, by a woman having had gestational diabetes, which has diabetes in pregnancy, or you can qualify via this risk test we just took here a minute ago. So those are, you know, kind of what the eligibility criteria are, you know, to be eligible for the program.

Scott Webb: Yeah, and we all need to be more probably physically active. I mean I can't speak for everybody, but, you know, most of us could stand to lose a few pounds and be more active. So when we put a number on that or we think about a daily amount of exercise that you would recommend to not only maybe prevent prediabetes, but prevent prediabetes from becoming type 2, what are we talking about? Is it like 30 minutes a day, something like that?

Tami Ross: Yeah, you've really kind of hit it right on the head. It's a pretty reasonable amount. Most people say 150 minutes a week and that would be what we call moderate intensity activity, something that gets your heart rate up. So it could be walking, it could be shoveling snow, raking leaves, but it averages out to about 30 minutes, five days a week. And that really is designed to help with the modest weight loss for the Diabetes Prevention Program. That's about 5% to 7% of your starting weight. So that really is what our goal is with that program.

Scott Webb: Yeah. That sounds pretty doable, you know, even in the winter months, especially if people have access to places they can work out indoors or walk or swim, you know, that kind of thing. You know, I just want to come back to the Diabetes Prevention Program. You mention the types of sessions and meetings, so maybe you can go over, you know, some of the topics that you cover? Are you doing these in person? Are you doing hybrid or only online? You know, maybe just kind of take folks through that.

Tami Ross: Yeah, sure. So the topics, it's a broad variety of topics ranging from eating well to learning how to read and understand the labels on the foods that we look at and buy, shopping and cooking tips. We spend a lot of time talking about how to fit in fitness and kind of sneak more movement into the day, burn more calories than you take in. And we focus on topics like eating well when you're at holiday and family events and when you're eating out. And then very importantly, how do you cope with triggers, maybe things that trigger you to eat and how to get support through that process. And so, with that, those are some of the core topics, really good variety.

As far as how we're offering the Diabetes Prevention Program right now, we currently are virtual. And so we're offering that over Zoom. We currently have three different groups running and we're actually getting ready to start a new one in January. So it will be meeting starting January 11th on Tuesdays over Zoom. It's open to anyone in the state of Kentucky and it'll be on Tuesdays around the lunch hour.

So if we've got listeners that, you know, were holding up five fingers or more on that risk test or think, "Hey, you know, I have some of these eligibility criteria," they can give us a call and we can really walk through that little screening with them and see.

And so the number they would call at UK Barnstable Brown Diabetes Center is (859) 323-7391, and folks can check us out online as well at ukhealthcare.uky.edu. And up on the right of the web page, you just search for the National Diabetes Prevention Program. It'll take them right to us. So that's how if individuals are interested or if we have providers even that are listening and think, "Hey, I may have patients to refer," that's how they can get referred as well.

Scott Webb: It's great, Tami. I love talking to you because you've done this type of thing before. So you dot all the I's cross all the T's. You have all the information at your fingertips. You are the dream guest. And I think maybe just the last thing, and this has been great fun, educational, really awesome. Folks are gonna want to know, you know, how much does it cost?

Tami Ross: Oh, that's the million dollar question, right? Well, the great thing is the Diabetes Prevention Program is covered by many insurance plans, including UK's insurance plans. But the really cool thing is the series that I mentioned that's starting in January, it actually is going to be supported by grants funding. And so we're able to offer that at no charge for this current series.

Scott Webb: Oh, wow.

Tami Ross: Yeah. So I would love, you know, to fill that group up and have people, you know, participate because really, as I like to think about it, the best time to prevent type 2 diabetes is right now. And so with this opportunity, we would love to have people call us and inquire and, just again, that phone number was (859) 323-7391.

Scott Webb: That's perfect, Tami. You know, you're the best, I mean, and as you say, there's no better time than now to prevent prediabetes, to halt, to reverse prediabetes. And you've given folks a clear path and all the resources and phone numbers and everything. You're awesome. Thank you so much, Tami, and stay well.

Tami Ross: Pleasure talking with you. Thanks.

Scott Webb: Please visit our website for more information regarding prediabetes and diabetes at ukhealthcare.uky.edu/barnstable-brown-diabetes-center. And that wraps up another episode of UK HealthCast from the University of Kentucky Healthcare. Please remember to subscribe, rate and review this podcast and all of the other University of Kentucky Healthcare podcasts. I'm Scott Webb. Thanks for listening.