The Cooper Institute
 

Founded in 1970 by the "Father of Aerobics"
Kenneth H. Cooper MD, MPH

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Prediabetes: A Common Risk Factor That You May Not Have Heard About

Posted in
Live well

Tuesday, Nov 14, 2017

If you are a fan of The Cooper Institute, I’ll bet that you already know that cardiovascular disease (CVD) is the leading cause of death in all developed countries. You may also know that having diabetes increases the risk of heart attack and stroke two to four-fold, and that rates of diabetes have been climbing steadily over the past three decades. In fact, it’s estimated that 30 million Americans (9% of the population) are currently living with diabetes. About 90% of these individuals have type 2 diabetes; which was formerly called adult-onset diabetes. Although the most common method of diagnosing diabetes is with a fasting blood glucose test, other blood tests such as Hemoglobin A-1C are also used. When fasting blood glucose is used as the criterion for diagnosing diabetes, a level greater than 125 mg/dL on two separate occasions indicates the presence of this condition. As a point of reference, a normal fasting blood glucose level is between 60 and 99 mg/dL.

You may not have heard as much about prediabetes. This is a very common condition where the fasting blood glucose level is between 100-125 mg/dL on two separate occasions. Prediabetes is an important risk factor for CVD, and it is currently estimated that 85 million Americans are living with prediabetes. So, when we put all the numbers together, approximately 33% of the U.S. population has diabetes or prediabetes! The Table below summarizes the three categories for fasting blood glucose levels.

Table 1. Fasting blood glucose categories.

Normal

60-99 mg/dL

Prediabetes

100-125 mg/dL on two separate occasions

Diabetes

>125 mg/dL on two separate occasions

 

So, the best way to think about prediabetes is as a condition where the fasting blood glucose level is higher than normal, but not high enough to be diabetes. Prediabetes is a significant condition not only because it places the individual at greater risk for CVD, but also because a substantial number of individuals with prediabetes go on to develop full-blown type 2 diabetes within several years!

So why do 85 million Americans have prediabetes? Great question! While genetics is sometimes a factor, the vast majority of individuals with prediabetes are either overweight/obese or do not perform sufficient amounts of regular physical activity. It really is that simple! This doesn’t mean that you have to look like a swimsuit model and exercise for hours each day to prevent prediabetes. In fact, moderate weight loss and meeting the public health physical activity guidelines* can go a long way towards preventing or even reversing prediabetes. Let’s look at an example:

Chuck is a 50 year-old male who is 5’9” and weighs 215 lbs. His fasting blood glucose level is 106 mg/dL, which places him in the prediabetes category. His body mass index (BMI)** is 31.7 kg/m2, which places him in the obese category. He consumes a lot of junk food and performs very little regular physical activity, but is otherwise reasonably healthy. Chuck decides to take action by making changes to his diet and physical activity level. He cuts back on empty calories (non-diet soda, chips, candy, pastry, cookies, alcohol, etc.) as well as saturated fat, and begins to eat more plant-based foods. This results in a consumption of about 400 calories less per day than usual. He also begins a progressive brisk walking program as outlined below, as well as a strength training program 2 days a week.

Chuck’s Walking Program

                     Days per Week     Minutes per Walk     Total Minutes Walking per Week

Week 1

        3

          20

         60

Week 2

        3

          25

         75

Week 3

        3

          30

         90

Week 4

        3

          35

       105

Week 5

        4

          30

       120

Week 6

        4

          35

       140

Week 7

        4

          40

       160

Week 8

        4

          45

       180

Week 9

        5

          40

       200

Week 10

        5

          45

       225

Week 11

        5

          50

       250

Week 12

        5

          55

       275

Week 13

        5

          60

       300

Week 14

maintain

     maintain

    maintain

 

Notice that Chuck did not begin his walking program by trying to meet the physical activity guidelines. He started slowly, and gradually increased the total minutes per week. By week 7, he was meeting the minimal guideline for good health*, and by week 13, he was meeting the minimal guideline for weight loss.* He manages to lose 20 pounds during this period of time. His BMI is now 28.8 kg/m2, with a fasting blood glucose of 95 mg/dL. Chuck has moved from the obese to the overweight category, and has also moved from the prediabetes to the normal fasting blood glucose category. As a bonus, Chuck noticed a reduction in his resting blood pressure. So while no magazines will be calling to ask Chuck to be a swimsuit model anytime soon, he has made a very significant positive change in his health status!

*Current guidelines recommend a minimum of 150 minutes per week of moderate aerobic activity and at least 2 days per week of strength training for good health. If weight loss is the goal, aim for a minimum of at least 300 minutes per week along with strength training at least 2 days per week.

**BMI is calculated by the following formula: weight in pounds x 703 / height in inches squared. For adults, a BMI between 18.5 and 24.9 kg/m2 is considered the normal body weight category. BMI’s between 25.0 and 29.9 kg/m2 are considered the overweight category, while BMI’s >30 are considered the obese category.  

Note: The Cooper Institute has recently published a state of the art textbook titled Principles of Health and Fitness for Fitness Professionals. This book is an absolute must for fitness leaders or anyone in the general population who wants to learn more about health and physical fitness. The book is also a great resource for anyone who is seeking to earn a nationally accredited personal trainer certification! Click on the links above to learn more.