A study just published in Lancet found that, in people with pre-diabetes, getting their blood glucose levels back to normal was associated with a cut by half in the number who went on to develop type 2 diabetes during the study period.
Coverage by BBC LINK
Abstract of the research paper, Lancet site LINK
With 35% of the US population age 20 years and older estimated to have pre-diabetes, it is urgent to understand this issue. (The US stats are easy to get and among the highest, but certainly this is a major issue developing all over the world.)
The next step is recognition that a major tool to achieve the goal of normal blood glucose is control over the form and amount of carbohydrates eaten, and that post-meal self-testing will reveal each person’s requirements, in balance with their personal choices and circumstances. This will bring normalization of blood glucose levels into the reach of almost all of those with pre-diabetes and diabetes (provided they have access to the resources and care needed), while enabling the least use of medication and therefore the least risk of medication side-effects.
There are three factors to be teased out here (the usual, more research needed):
- the degree to which having lower levels of glucose in the blood lessened progression of damage to the insulin secreting cells of the pancreas, or other damaging effect of glucose levels above normal
- the degree to which some people were less able to achieve normal blood glucose levels because of strictly physical factors, such as how much damage they already had to the insulin-secreting cells of the pancreas. (That is, the degree to which the people who achieved normal blood glucose were a different group of people than the ones who did not achieve normal blood glucose. In that case, the ability to return to normal blood glucose levels would be a “marker” that distinguishes one group at less risk from another group at more risk – rather that being a “cause” of protection or progression)
- the degree to which the people who did not achieve normal blood glucose readings were less engaged in trying to improve their blood glucose levels, which might suggest that they are people who do not take as much care of their health in other ways.
Curiously (or not curiously at all, when you think about it), among those who did not return to normal blood glucose levels, the group assigned to “intensive lifestyle” changes fared worse that the placebo group. Why could that be? It is highly likely that part of what they were taught as “intensive lifestyle intervention” was the usual higher carb, low-fat diet.
“Among participants who did not return to normal glucose regulation in DPP, those assigned to the intensive lifestyle intervention had a higher diabetes risk (HR 1·31, 95% CI 1·03—1·68, p=0·0304) and lower chance of normal glucose regulation (OR 0·59, 95% CI 0·42—0·82, p=0·0014) than did the placebo group in DPPOS.”
I hope this study gets wide media attention and that it spurs much more investigation into the damaging effects of “non-diabetic” levels of high blood glucose.
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