Does prediabetes always lead to diabetes?
By Wil Dubois
My new patient was scared. I could see it in her eyes, open a little wider than usual, pupils dilated. Tears pooled in the corners, just short of overflowing and running down her cheeks. She held her body rigid, elbows close to her sides. She had a death grip on her purse, which she held in her lap.
She tried to hold her voice steady as she asked me the question. Although I didn't understand her exact words, I knew what she was asking me. Still, I politely waited for my translator, who said simply, "She wants to know if she has diabetes yet, or not."
I had reviewed her lab tests before entering the treatment room. I knew her average blood sugar for the past three months was waaaaay higher than normal, but not high enough for a diagnosis of diabetes. Not yet. She was in the twilight world between normal health and diabetes, what we in the medical trenches call "abnormal blood glucose." Something you know as prediabetes.
Putting on my best mock-stern face, I carefully explained that she did not have diabetes. Not yet. But that if she tried really hard — overate, stopped exercising, and put on some weight — that I was confident that we could get her the rest of the way there in six months to a year.
As my translator started explaining, my patient's jaw dropped. "Pero no quiero tener la diabetes!"
I didn't need a translator for that. She didn't want to join my club. I feigned surprise, with a slight grin. "No? Are you sure? Well, OK, then...If that's what you really want...We'll help you prevent diabetes instead..."
The journey from prediabetes to diabetes
Can you be a little bit pregnant? No. Either you are or you aren't. Can you have a little bit of cancer. No. You either have it or you don't. Can you have a touch of hepatitis? No. Either you do or you don't. But type 2 diabetes is unique. It does have shades of gray. It's a continuum that ranges from "normal" to "holy crap!" At the holy-crap end, you have full blown diabetes. It will never go away and it will only get worse over time, no matter what efforts you make to fight it. It's a chronic, progressive (but controllable) disease.
But where's the point of no return? Does prediabetes always lead to diabetes? Is there a treatment for prediabetes? Those were questions without clear answers for many, many years. But they were answered beyond a shadow of a doubt back in 2002.
That's when the results of a several-year study of intervention efforts on 3,234 people with prediabetes were published. This study, called the Diabetes Prevention Program (DPP), proved definitively that it is possible to prevent or delay diabetes.
Wait a sec. Prevent or delay? That's a big difference, you say. Which is it? Well at the time, all that the researchers knew for sure was that one particular prescription could help the majority of people with prediabetes "duck the bullet." It kept them, frankly, a little bit pregnant. They didn't really get back to "normal" blood sugars, but they didn't go on to get diabetes, either. How big a majority? Fifty-eight percent, or about six out of ten of the people with prediabetes who took this prescription didn't "convert" to full-blown diabetes.
That's pretty amazing.
But the study was only a few years ago. At the time, the clinical researchers didn't know for sure if they actually prevented anything at all, or if they just slowed down the inevitable.
That was a decade ago. A recent follow up of the original participants shows that fully 34% of them still remain diabetes free. And other studies back up these results. A study in Finland shows similar success, and a study out of China shows that after 20 years, the same prescription has kept 43% of study participants diabetes free.
That sounds like a cure to me.
And even if all those people got their diabetes tomorrow, there's still a helluva lot to be said for delaying your diabetes for two decades, if you can. More on that in a bit.
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Many people say that depression is a side effect or complication of diabetes. Without discounting the association of the psychological condition with the physical one, I'm not convinced that our high and/or unstable glucose levels are directly responsible for that change in our mental state. My belief is that the unrelenting need for self-care, for following the sort of care schedules that can drive licensed, professional caregivers crazy, is what overwhelms us...