Pre-diabetes is worth treating

DIAGNOSING disease is not always a black-and-white undertaking. There is often a gray zone between sickness and health -- a time when, technically speaking, people can't be classified as either diseased or well. Diabetes serves as a perfect example -- so much so that the gray zone has earned its own name: pre-diabetes.

As its name implies, pre-diabetes is essentially a precursor to diabetes. People with pre-diabetes have blood glucose levels above those considered normal but not yet high enough to qualify as diabetic.

According to the Centers for Disease Control and Prevention, nearly 57 million Americans 21 and older have the condition, roughly twice as many as have diabetes itself. Pre-diabetes is not only more common but also more treatable. If it's diagnosed early, its ill effects can often be averted. In some cases, the condition can be cured.

Pre-diabetics have problems responding to insulin, the hormone that processes glucose in the body, causing the rise in blood sugar levels -- in medical terms, this is known as insulin resistance. "As resistance goes up, more and more insulin is needed to handle the same amount of glucose," says Dr. Yehuda Handelsman, co-chairman of the American College of Endocrinology's task force on the management of pre-diabetes.

Mild elevations in glucose levels cause no obvious symptoms but carry significant consequences: A persistent buildup of glucose in the body damages blood vessels and other tissues throughout the body. "It's clear that the risks of high blood glucose levels occur earlier than those at which diabetes is currently defined," Handelsman says. Many of the complications of diabetes -- such as cardiovascular, kidney and eye disease -- actually begin during this early phase of the illness. People with pre-diabetes already have a 50% higher risk of heart disease and stroke than those with normal blood glucose levels.

Pre-diabetics are also far more likely to go on to develop full-blown diabetes. If left untreated, about 25% of individuals with pre-diabetes progress to diabetes within three to five years, and many more will develop the disease within a decade.

With appropriate treatment, however, individuals with pre-diabetes can prevent -- or at least delay -- their condition from worsening. In fact, studies suggest that simple lifestyle changes are often enough to overcome insulin resistance and return blood glucose levels to normal.