Aug. 1, 2020 : Issue #1053 TOP STORIES - Diabetes News & Research |
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Letter from the Editor
 Living in Florida looks dangerous to everyone that is in the rest of the US. We have the second highest number of positive results for COVID-19, and on Tuesday we set yet another new record for deaths. Our Governor is advocating that in-person schooling is not a risk, and although he says to wear a mask in public, he has yet to make it a mandatory state rule.
His reasoning deals with the fact that most newly diagnosed people are young and healthy and if they get infected, they likely will be asymptomatic and they won’t have any complications. He has even mentioned herd immunity as a reason not to become more restrictive.
When Steve and I were chatting about this a couple of weeks ago, he made the connection to the governor's opinion on COVID-19 and the idea of a patient having Pre-Diabetes. I had to agree there are some similarities, as we use the term Pre-Diabetes to lessen the severity of a patient's current condition and what may or may not happen in the future.
This week, Steve, along with 3 of our interns, Fairuz Afram, PharmD Candidate, University of Colorado College of Pharmacy; Louise Brown, PharmD Candidate, University of Colorado College of Pharmacy; and Chardae Whitner, PharmD. Candidate, Lake Erie College of Osteopathic Medicine, have put together a full issue on why Pre-Diabetes is a disease and not just a condition.
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We can make a difference!
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Dave Joffe
Editor-in-chief |
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TOP STORIES - Diabetes News and Research |
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| Fact: Why Do We Have A Disease Called Pre-Diabetes? Think About what It Means to the Patient!
When a pre-disease can increase the risk for death, isn't that a disease, or should we wait for the complications to occur and then call it a disease?
According to the CDC, there are approximately 90 million people with this disease. By 2030, an estimated 470 million people will have pre-diabetes. And an expert panel at the American Diabetes Association (ADA) estimates up to 70% of people with pre-diabetes go on to develop type 2 diabetes. As a medical professional & diabetes educator, I have always been mystified as to why we call it pre-diabetes, when even those with pre-diabetes have the beginnings of the complications from diabetes, including the risk for death. When we tell a patient that they have pre-diabetes, they take that to mean it is not that important; and they are told to watch what they eat and exercise more, and we will see you next year.
So, what is the worst thing that can happen if we call it diabetes and diagnosis it when the A1c is higher than 5.6%? Patients would take it more seriously and most likely make changes to lose weight and exercise more. We might even provide them with a prescription for metformin and redo the A1c in 90 days, and if it was lower, use that fact to motivate the patient to work even harder. We should not wait until they get diagnosed with the current level of an A1c of 6.5%. At that point, it will be more challenging to get them back to below an A1c of 5.7%. Why wait until their A1c is above 6.5% before we have them take it more seriously; what harm can be done to start the recommendations and treatments much earlier? For those who never get diabetes, they will be healthier.
The current analysis, which included 129 studies, with over ten million individuals from multiple countries including ninety-seven studies with a median follow up of 9.8 years, reported the primary outcome in the general population and showed that there is an association between pre-diabetes and all-cause mortality and cardiovascular disease. The meta-analysis found that in the general population, pre-diabetes was associated with a 13%, 15%, 16%, and 14% increased risk of all-cause mortality, CVD, coronary heart disease, and stroke, respectively, over a median follow-up of 9.8 years.
Expressed differently, each year, there were 7.4 more deaths, 8.8 more cases of CVD, 6.6 more cases of coronary heart disease, and 3.7 more strokes among 10,000 people with pre-diabetes than among the same number of people with normal blood glucose levels.
Among patients with preexisting atherosclerotic CVD, having pre-diabetes was associated with even higher risks: a 36%, 37%, and 15% increased risk of all-cause mortality, CVD, and coronary heart disease, respectively, over a median follow-up of 3.2 years.
One day soon, the health organizations will see the light and will make that change and remove pre-diabetes from our vocabulary. But you can start now with your patients.
Pre-Diabetes = Diabetes
Steve Freed, R.Ph., CDE, Publisher |
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| Diabetes in Control gratefully acknowledges the assistance of the following pharmacy doctoral candidates in the preparation of this week’s newsletters: Fairuz Afram, PharmD Candidate, University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Sciences Louise Brown, PharmD Candidate, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences Zahra Hashemy, PharmD. Candidate, USF Taneja College of Pharmacy Maya Palmer, PharmD. Candidate, Florida A&M University College of Pharmacy Nour Salhab, Pharm.D. Candidate, USF College of Pharmacy Chardae Whitner, PharmD Candidate L|E|C|O|M Bradenton School of Pharmacy |
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| Your Friends in Diabetes Care
Steve and Dave
Diabetes In Control
810 Bear Tavern Road Suite 102
Ewing, NJ, 08628
USA
www.diabetesincontrol.com |
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