Pre-diabetes

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Pre-diabetes is a condition in which blood glucose levels are elevated, but are not high enough to be labeled as diabetes. About 57 million people in the U.S. are believed to have pre-diabetes. Though they don’t fit the diabetes classification, elevated glucose levels and/or impaired ability to use glucose puts them at risk for developing diabetes later in life. The National Institute of Diabetes and Digestive and Kidney Diseases reports many people with pre-diabetes develop type 2 diabetes within ten years.

More importantly, research suggests that some of the long-term damage to the body may begin before the onset of real diabetes. The American Diabetes Association says pre-diabetics have 1.5 times the risk of cardiovascular disease as those with normal blood sugar levels.

Preventing Type 2 Diabetes: The “Y” Program

Several years ago, a large nationwide study, called The Diabetes Prevention Program, found lifestyle interventions could greatly prevent or delay the onset of type 2 diabetes in high-risk patients. The researchers found 30 minutes of moderate exercise a day along with a weight loss of 5 to 10 percent reduced the risk of diabetes by 58 percent.

Many physicians offer diabetes prevention educational programs for patients. But the one-on-one training and counseling is costly. And patients are not always motivated to comply with dietary, lifestyle and exercise recommendations.

Researchers at Indiana University School of Medicine are testing a program to bring lifestyle interventions to the community through small group (8 to 12 people) instruction at local YMCAs. In a pilot study, investigators measured participants’ weight and took blood samples to measure glucose and cholesterol levels at the start of the classes. The program involved weekly group visits of 60 to 90 minutes for four months. The weekly classes are followed with monthly maintenance sessions.

Instructors use a modified format of the Diabetes Prevention Program to provide education about lifestyle changes, physical activity and diet. Some classes provide tips on diet management for holidays, cook-outs and restaurant dining. Groups talk about ideas for exercise and meet for walks or other forms of physical activity. Participants also work on problem-solving skills. After six months, researchers found participants lost an average of 6 percent of their body weight and had significantly improved total cholesterol levels.

Ron Ackermann, M.D., Primary Care Physician, says the “Y” format is much less costly than the traditional Diabetes Prevention Program education (about $240/year for the Y program versus $1,500 for the traditional program). The savings come from using Y employees who are retired nurses or certified wellness instructors (as opposed to highly paid instructors in the traditional setting). In addition, up to 12 people can be taught at one time. Participants also like the small group format because they receive motivation and support from others in the group.

Researchers would like to develop uniform standards so the Y program can be expanded to other areas of the country. Ackermann says the program could be run by other community organizations as well. For information about the study, go to http://clinicaltrials.gov. Then type the trial identification number in the search box: NCT00302042.