'Pre-Diabetes' Tests Urged for Overweight Americans

The government yesterday for the first time urged overweight Americans to get tested for a newly defined condition called "pre-diabetes" as part of a campaign to stem a growing epidemic of diabetes in the United States.

The recommendation was prompted by the recent recognition that people who are at risk of developing diabetes can be identified and their risk of going on to develop the full-blown disease can be cut substantially by weight loss and exercise.

"Diabetes has reached epidemic proportions and it's still on the rise," Health and Human Services Secretary Tommy G. Thompson said at a briefing yesterday. "What gives us hope . . . is that people with pre-diabetes can take meaningful steps now to reduce their risks and avoid having diabetes."

The rising incidence of diabetes in the United States is the result of a dramatic increase in obesity, as well as the aging of the population. The latest figures show that in addition to the estimated 17 million Americans who have full-blown diabetes, at least an additional 16 million have "pre-diabetes," Thompson said.

People with pre-diabetes have levels of glucose (a sugar in the bloodstream) that are higher than normal but not high enough to be classified as diabetes. It causes no symptoms, but without treatment most people with the condition go on to develop diabetes, which is the sixth leading cause of death in the United States and a major contributing cause of heart disease, stroke, kidney failure, high blood pressure and blindness.

A new campaign, sponsored by HHS and the American Diabetes Association (ADA), seeks to inform the public and health care professionals about the need to identify and treat pre-diabetes.

"Some people have . . . become fatalistic, believing diabetes is inescapable," said Judith Fradkin of the National Institutes of Health. "Those are the people we most need to reach with this message that diabetes can be stopped."

Thompson said HHS will also try to persuade health insurers and employers to pay for testing and treatment to prevent diabetes, a disease that is estimated to cost the U.S. economy $100 billion annually. Except for certain screening tests mandated by Congress, the federal Medicare program does not pay for preventive treatment.

According to the new recommendations, pre-diabetes can be diagnosed by either of two blood tests. A fasting plasma glucose (FPG) test measures the level of glucose in the bloodstream after an overnight fast. A two-hour oral glucose tolerance test (OGTT) includes the FPG test and measures the glucose level two hours after the person being tested drinks a solution containing glucose.

The guidelines state that testing is strongly recommended for anyone who is 44 or older and overweight (defined as a Body Mass Index of 25 or higher). They say doctors should also consider testing people older than 44 who have no risk factors, as well as younger adults who are overweight and who have at least one other risk factor for diabetes.