Wednesday, February 27, 2019

Confronting Prediabetes

Although not commonly listed as a chronic disease, prediabetes is a chronic disease that carries many risks. It raises the risk of type 2 diabetes, and it raises the risk of stroke and heart attack. According to the CDC, 84% of the adults in America have prediabetes. Further, most people who have prediabetes are not aware that they have the condition. It is estimated that 90% of people who have prediabetes don’t know they have prediabetes. The sooner prediabetes is diagnosed, the faster prediabetes treatment can start. So methods to predict prediabetes and to treat prediabetes can benefit at least 1/3 of the US adult population.

One study done in China indicated that it may be possible to isolate individuals in lean populations who may be at a high risk of prediabetes and diabetes. During a six year period, approximately 800 children and adults were studied who eventually developed prediabetes or diabetes. Seven hundred and thirty seven of the studied subjects were lean at baseline and during the follow-up phase.

The investigators concluded that even if they are lean, individuals whose fasting glucose is in the top tertile of the normal fasting glucose range have a higher risk of prediabetes and diabetes. And this is often overlooked because individuals are not overweight or obese.

Furthermore, when prediabetes is diagnosed in a patient, the condition is typically not addressed by the clinician. In one study, only 22.8% of patients with prediabetes between 2013 and 2015 indicated that they were treated for the disease. Treatment for prediabetes commonly includes lifestyle change. But patients with hyperlipidemia or obesity were more likely to be treated with lifestyle change than those with prediabetes.

Therefore, based on the above studies, physicians and other practitioners should pay more attention to patients who are close to the upper limits of the normal fasting glucose and other glucose measurement guidelines. Further, practitioners should treat prediabetes more aggressively in the future. By taking the appropriate actions, practitioners can do a lot to reduce the number of patients who eventually get type 2 diabetes.


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Sunday, February 24, 2019

Insight into Glucose Metabolism May Lead to Personalized Nutrition

Macronutrients in our diet include proteins, carbohydrates and fats. It is often said that calories and not macronutrient combinations are what lead to weight loss. So, if you want to lose weight, you need to lower your calorie intake. And changing the macronutrient combination or content will not lead to weight loss. Indeed, with some qualifications, the above statements are probably true, in general. However, one study has indicated that fasting glucose and fasting insulin concentrations, combined with specific macronutrient compositions, may be good predictors of weight loss. Further, different concentrations can lead to different amounts of weight loss.
The participants in the study were randomized to an ad libitum low carbohydrate diet or low-fat diet where the calorie intake was 1200 hundred to 1800 calories per day. The study lasted 24 months. At the end of the study period, participants who had prediabetes and high fasting insulin lost more weight on the low-fat diet than on the low-carbohydrate diet, while participants who had prediabetes and low fasting insulin lost more weight on the low-carbohydrate diet than on the low-fat diet.  
The investigators concluded that “Fasting plasma glucose and insulin are strong predictors of the weight loss response to diets with different macronutrient composition and might be a useful approach for personalized weight management.”
We think these findings are important. The indications are that by gaining insight into a prediabetic patient's fasting glucose and fasting insulin concentrations, a practitioner can better personalize the patient’s diet.
And if the patient's diet can be personalized in a way that enables the patient to lose weight, the weight loss will likely have other benefits, such as resolving a person’s prediabetes, and lowering the risks for conditions associated with prediabetes. These conditions include type 2 diabetes, stroke and heart problems. Practitioners should attempt to embrace personalized medicine when it can be of use to patients.

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