Most Older Adults with ‘Prediabetes’ Don’t Develop Diabetes

Lisa Rapaport wrote . . . . . . . . .

Older adults with slightly elevated blood sugar, sometimes called “prediabetes,” usually don’t develop full-blown diabetes, a Swedish study suggests.

Researchers followed 2,575 men and women aged 60 and older without diabetes for up to 12 years. At the start of the study, 918 people, or 36% of the group, did have higher-than-normal blood sugar levels that were still below the threshold for diabetes.

Only 119 people, 13% of those who started out with elevated blood sugar, went on to develop diabetes. Another 204, or 22%, had blood sugar levels drop enough to no longer be considered prediabetic.

“Progressing to diabetes is not the only destination,” said lead study author Ying Shang of the Aging Research Center at the Karolinska Institute in Stockholm.

“In fact, the chance to stay prediabetic or even revert back to (normal blood sugar) is actually pretty high (64%), without taking medication,” Shang said by email. “Lifestyle changes such as weight management or blood pressure control may help stop prediabetes from progressing.”

Average blood sugar levels over the course of about three months can be estimated by measuring a form of hemoglobin that binds to glucose in blood, known as A1c. Hemoglobin A1c levels of 6.5% or above signal diabetes.

Levels between 5.7% and 6.4% are considered elevated, though not yet diabetic, while 5.7% or less is considered normal.

Worldwide, about 352 million adults have elevated blood sugar that’s not high enough to warrant a diabetes diagnosis, the study team notes in the Journal of Internal Medicine. By 2045, that’s projected to rise to 587 million, or 8.3% of adults worldwide.

People in the study with prediabetes were more likely to return to healthy blood sugar levels if they lost weight, were free of heart disease and had low blood pressure.

Obese adults with prediabetes were more likely to progress to full-blown diabetes.

The study wasn’t designed to determine why people with prediabetes might progress to full-blown disease or return to healthy blood sugar levels.

One limitation of the study is that it had too few people with prediabetes to draw broad conclusions about how the condition might progress for millions of people worldwide. Researchers also lacked data on what lifestyle changes, such as shifts in eating or exercise habits, people might have used to try to reverse prediabetes.

“Larger studies will be needed to confirm these findings, and more treatment and lifestyle information would be needed to better understand why less people became diabetic than anticipated,” said Dr. R. Brandon Stacey of Wake Forest University School of Medicine in Winston-Salem, North Carolina.

“By having more lifestyle and treatment information, it may be possible to better identify patterns that enabled patients to successfully lose weight or lower their blood pressure to potentially reduce the risk of diabetes,” Stacey, who wasn’t involved in the study, said by email.

Even so, the results suggest that a diagnosis of prediabetes should motivate patients to make lifestyle changes, said Dr. Ron Ruby, co-director of the cardiometabolic center at Providence Little Company of Mary Medical Center in Torrance, California.

“Optimize the things you can control; weight loss, diet, exercise, and sleep,” Ruby, who wasn’t involved in the study, said by email. “This approach, though challenging to maintain for the long term, may be sufficient to prevent the progression to diabetes.”

Source: Reuters

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Study: Red Raspberries May Help with Glucose Control in People with Pre-diabetes

A study released today from the Illinois Institute of Technology shows the benefits of including red raspberries in the diet of individuals with pre-diabetes and insulin resistance.

According to the Centers for Disease Control and Prevention (CDC), an estimated 34 percent of American adults, around 84.1 million in all, had prediabetes in 2015. Patients with prediabetes are at higher risk for a number of conditions – including developing type 2 diabetes, cardiovascular disease and Alzheimer’s disease.

The study, published in Obesity, investigated the effects of red raspberries in a group of people at-risk for diabetes who were overweight or obese and presented with prediabetes and insulin resistance. A metabolically healthy control group was also included in the study for reference.

Using a randomized, controlled, acute study design, 32 adults between the ages of 20-60 years had their blood tested over a 24-hour period after eating breakfast on three separate days. The three breakfast meals were similar in calories and macronutrients, but differed in the amount of frozen red raspberries – one meal contained no raspberries, one contained one cup of raspberries and one contained two cups of raspberries.

The results showed that as the amount of raspberry intake increased, individuals at risk for diabetes needed less insulin to manage their blood glucose. When two cups of red raspberries were included in the meal, glucose concentrations were lower compared to the meal with no red raspberries. The data suggests that simple inclusion of certain fruits, such as red raspberries with meals, can have glucose lowering benefits with indications of improvements in insulin responses. These effects are particularly important for people who are overweight or obese with pre-diabetes.

“People at risk for diabetes are often told to not eat fruit because of their sugar content. However, certain fruits – such as red raspberries – not only provide essential micronutrients, but also components such as anthocyanins, which give them their red color, ellagitannins and fibers that have anti-diabetic actions,” said Britt Burton-Freeman, Ph.D., director, Center for Nutrition Research at Illinois Tech. “For people who are at risk for diabetes, cardiovascular disease and other health risks, knowing what foods have protective benefits and working them into your diet now can be an important strategy for slowing or reversing progression to disease.”

Source: EurekAlert!

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Lifestyle Strategies for Reversing Prediabetes

Jill Weisenberger wrote . . . . . . . . . .

It’s Not All About Weight Loss

A shocking 84 million adults in the United States are estimated to have prediabetes. Perhaps even more shocking is that a mere 12% of them have received the diagnosis.1 The other 70 million are unaware they have a disorder that places them at increased risk of developing type 2 diabetes, heart disease, stroke, and even some types of cancer. To increase awareness, the Centers for Disease Control and Prevention and other organizations are running a multimedia campaign. Dietitians can help people with prediabetes by sharing evidence-based recommendations tailored to their specific needs.

A well-known and effective type 2 diabetes prevention strategy is weight loss. Both the federally funded Diabetes Prevention Program and the Finnish Diabetes Prevention Program showed that losing weight lowered the risk of developing type 2 diabetes among people at high risk. But not everyone with prediabetes needs to lose weight, and many individuals with extra weight or obesity don’t want to focus on weight loss. Fortunately, there are additional lifestyle strategies to reduce the risk of type 2 diabetes and perhaps even reverse prediabetes.

Eating Patterns

When the emphasis is on wholesome foods, an array of eating patterns may improve glycemia among people with prediabetes, explains Tami Ross, RD, LD, CDE, MLDE, a nationally recognized speaker, book author, and past president of the American Association of Diabetes Educators, who provides nutrition counseling and diabetes self-management education and support. Personalizing the diet plan while considering individual goals, health beliefs, culture, religion, economics, and metabolic goals is critical, she says. Below are three dietary patterns that show promise for managing or reversing prediabetes.

Mediterranean-Style Diet

A large meta-analysis of more than 100,000 participants from around the world found that those whose diets most resembled a Mediterranean style were 23% less likely to develop diabetes.2 The PREDIMED study found that after four years, those participants assigned to follow a Mediterranean-style eating pattern were 52% less likely to develop type 2 diabetes than those assigned to a low-fat diet. Though the specific foods eaten in countries surrounding the Mediterranean Sea vary by locale, this dietary pattern centers around fruits, vegetables, whole grains, olive oil, nuts, and other plant foods. In addition, clients will benefit from eating fish at least twice weekly. Wine is frequently consumed with a meal, and fruit is a typical dessert.

The DASH Diet

Though the Dietary Approaches to Stop Hypertension (DASH) diet was created and studied to lower blood pressure, ongoing research finds it beneficial for those with prediabetes. A meta-analysis of prospective cohort studies found that the DASH diet reduced the risk of developing type 2 diabetes by 20%.3 In the PREMIER study, individuals with high blood pressure who followed a DASH eating plan experienced improved fasting insulin and glucose levels as well as enhanced insulin action.4 Additional research shows that the DASH eating pattern improves dyslipidemia, lowers CVD risk, and is linked to lower risk of obesity.5 Though similar in many ways to a Mediterranean-style diet, the DASH eating plan is lower in fat and richer in animal foods, promoting consumption of fruits, vegetables, poultry, fish, nuts, whole grains, and nonfat and low-fat dairy products.

Vegan and Vegetarian Diets

Epidemiologic studies support the use of vegan and vegetarian diets in the prevention of type 2 diabetes. For example, researchers from the Adventist Health Study-2 found that vegan diets protected against type 2 diabetes compared with nonvegan diets even when they accounted for other lifestyle factors and BMI. In this study, all types of vegetarian diets offered some protection compared with nonvegetarian diets.6 Possible mechanisms for this reduced risk include greater fiber and low heme iron intakes and healthier weight status.7

Individual Foods

Though the emphasis should be on an overall healthful eating pattern, the American Diabetes Association (ADA) reports there’s evidence that eating specific foods may help lower risk. Higher intakes of coffee, tea, yogurt, berries, and nuts are associated with reduced risk of type 2 diabetes.8 Other foods have been studied for their effects on insulin sensitivity and glycemic control. Several foods with potential benefit include the following:

  • Oats and barley. These whole grains contain the viscous fiber beta-glucan, which improves insulin action and lowers blood glucose levels. As a bonus, it sweeps cholesterol from the digestive tract, lowering blood cholesterol levels and reducing CVD risk.9
  • Legumes. Studies show that diets rich in beans, peas, and lentils have beneficial effects on both short-term and long-term fasting blood glucose levels.10 Possible mechanisms include their magnesium, phytonutrients, dietary fibers, and resistant starches, which resist digestion in the small intestine and are later fermented by bacteria in the colon.
  • Nuts. Though each type of nut has a unique nutrient profile, nuts are a source of unsaturated fats, magnesium, folate, fiber, and a host of phytonutrients.
  • Berries. A Finnish study found that middle-aged and older men who consumed the most berries had a 35% lower risk of developing type 2 diabetes.11
  • Yogurt. Researchers following participants in the Health Professionals Follow-Up Study, the Nurses’ Health Study, and the Nurses’ Health Study II found that an increase of one serving of yogurt per day was associated with an 18% reduced risk of developing the disease. The mechanism by which yogurt influences diabetes risk is unclear, but it may be related to its probiotics or unique nutritional profile.12
  • Coffee and tea. The habitual consumption of either beverage is associated with decreased risks of developing type 2 diabetes. Mechanisms are unclear and may be related to the unique phytonutrients present in coffee and tea.13,14 Dietitians should advise clients to avoid common high-calorie add-ins such as whipped cream, heavy creamers, and syrups.

Moreover, the ADA states that red meats and sugar-sweetened beverages are associated with a greater risk of the disorder.8 Overall, a balanced eating pattern with an emphasis on wholesome food choices rather than macronutrient distribution appears effective in decreasing the risk of developing type 2 diabetes.

Physical Activity

Even without weight loss, moving the body helps prevent type 2 diabetes.

1. Cardiovascular exercise. The ADA recommends people at risk of type 2 diabetes engage in at least 150 minutes of moderate-intensity physical activity, such as brisk walking, each week.8 Exercise improves insulin resistance for two to 48 hours, so clients should be encouraged to exercise as frequently as possible, even if they don’t make time for the full 150 minutes each week. To help resistant or hesitant clients achieve the exercise goal, Nashville-based Lindsey Joe, RDN, LDN, a DPP Lifestyle Coach, encourages them to break it up into 10-minute sessions. “It’s amazing where you can find pockets of time if you prioritize using them for activity and not scrolling on social media,” she says.

2. Lift weights. “Resistance training is probably the most important exercise of all for anyone wanting to prevent type 2 diabetes,” says Sheri Colberg, PhD, FACSM, a professor emerita at Old Dominion University in Norfolk, Virginia. “We store most of the carbohydrates we eat in our muscles.” Resistance training builds more muscle, giving us more storage capacity for blood glucose, she says.

3. Reduce sedentary time. Even regular exercisers should avoid prolonged periods of sedentary behavior. The ADA recommends breaking up periods of inactivity with at least three minutes of walking, leg lifts, standing, or other light activity every 30 minutes. These activities stimulate the muscles to use blood sugar, Colberg says.


When time is tight, many people skimp on sleep without knowing that shortened sleep or poor sleep can harm their health. In a meta-analysis of 482,502 participants, researchers observed a U-shaped dose-response relationship between sleep duration and risk of type 2 diabetes. The lowest risk of developing the disease was associated with a sleep duration of seven to eight hours per night.15 Research suggests that chronic and acute sleep deprivation impact glucose metabolism. For example, in a small study of healthy adults, one night of sleep restricted to four hours resulted in decreased insulin sensitivity of 19% to 25%.16 Dietitians can coach clients to set goals around bedtime and look for solutions to common obstacles of getting too little sleep.

Though the majority of people with prediabetes will benefit from losing weight, it isn’t the only successful strategy for diabetes prevention or delay. Even in the absence of weight loss, healthful eating, physical activity, and other lifestyle behaviors can improve health and prevent or delay the onset of type 2 diabetes.

Source: Today’s Dietitian

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What is Prediabetes

It’s estimated that 84 million Americans (greater than 1 in 3) have prediabetes — a condition that raises the risk for developing Type 2 diabetes, heart disease and stroke.

Also referred to as impaired fasting glucose or impaired glucose tolerance, prediabetes occurs when your blood glucose (blood sugar) levels are higher than the normal range but not high enough to be diagnosed with Type 2 diabetes.

If left untreated, prediabetes may develop into Type 2 diabetes. Fortunately, changes in lifestyle — such as managing food choices and increasing physical activity — can help return blood glucose levels to normal.

What Are the Risk Factors?

A direct cause for prediabetes has not been determined, but excess body fat, especially in the abdomen, and inactivity are two key factors. There are few symptoms associated with the onset of prediabetes.

You are at higher risk if:

  • You are 45 years old or older and have an overweight body mass index; or
  • You are younger than 45 years old and have an overweight BMI with a history of inactivity, high cholesterol, high blood pressure, or have a family member with diabetes.

What Does a Diagnosis Mean?

With prediabetes, your body may be producing less insulin, your insulin sensitivity may be decreasing, or a combination of both. Insulin regulates the level of blood glucose helping your body turn carbohydrates into energy. Having high blood glucose puts you at risk for developing some long-term effects associated with diabetes such as blindness, damage to nerves and kidneys, and circulatory system problems.

Managing Prediabetes

The CDC-recognized National Diabetes Prevention Program has helped many people make healthy lifestyle changes to reverse prediabetes and prevent Type 2 diabetes. Consider finding a program near you. Everyone with prediabetes can slow the disease progression by following these strategies:

  • Exercise for at least 150 minutes per week. Start by walking for 30 minutes a day, five days a week.
  • Eat a balanced diet including fruits, vegetables, whole grains, protein foods and calcium-rich foods.
  • Work with a registered dietitian nutritionist to help you make lasting healthy habits.

A Healthy Meal Plan

Following a balanced diet and eating meals at consistent times can help with blood glucose control. Glucose comes primarily from the foods that we eat, specifically carbohydrates — and it’s not just sweets. While all carbohydrate-containing foods affect your blood glucose levels, they also play an important role in your overall health by providing energy for your daily activities. You do not need to cut carbohydrates out of your diet!

When putting together a meal plan, include a variety of the following foods:

  • Grains – whole-grain pasta, breads and cereals, and brown rice
  • Vegetables – spinach, romaine, tomatoes and other colorful vegetables
  • Protein – lean meat, chicken, fish, lentils, beans, tofu and tempeh
  • Dairy – low-fat or fat-free yogurt, low-fat or fat-free milk, and fortified soy milk
  • Fats – avocado, walnuts, olive oil

Source: Academy of Nutrition and Dietetics

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Give Prediabetes the Boot

One in three adults have prediabetes. If results from two new studies pan out, the right diet and exercise program could dramatically lower risk.

Cutting Carbs

Researchers randomly assigned 38 people who had prediabetes and were obese to one of two diets. Each cut 500 calories a day.1

After six months, 14 people had dropped out. However, blood sugar levels in all of the remaining 12 people on the higher-protein diet—but in only four of the remaining 12 on the higher-carb diet—had fallen into the normal range. What’s more, the higher-​protein group had lower hemoglobin A1c (a long-term measure of blood sugar) and lower LDL (“bad”) cholesterol, triglycerides, and some markers of inflammation.

Both groups lost the same amount of weight, but people on the higher-protein diet lost only fat, while those on the higher-carb diet lost both fat and muscle.

What to do: If you have prediabetes, try cutting back on carbs. (That will cut your calories and make protein a higher percentage of your diet.) Although this small study needs to be replicated, it’s worth a try. And you needn’t cut all carbs. You can still enjoy vegetables and fresh fruit, with small servings of grains.

Resist Diabetes

Strength training may also help make prediabetes disappear.

The Resist Diabetes trial enrolled 159 sedentary overweight or obese adults with prediabetes in a strength-training program for three months.2 Twice a week, they did 12 supervised exercises (like leg presses, chest presses, and abdominal crunches) for 8 to 12 repetitions each.

Then each participant was given one of two different levels of encouragement for six months, followed by six more months when they were on their own.

After the 15 months, 30 percent of the participants no longer had prediabetes. It made no difference whether they received more or less encouragement.

Although the volunteers didn’t lose weight, their waistlines did shrink. And those who gained the most muscle were the most likely to reverse their prediabetes.

What to do: If you’re not doing strength training, get started. People lose muscle as they age. Building strength is the best way to stop or reverse that loss, whether or not you have prediabetes.

Source: Center for Science in the Public Interest

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