Diabetes Archive

Q. I have coronary artery disease, and my primary care doctor just told me that changes in my tests indicate I have prediabetes. This doesn't sound like a big deal, since I don't need medicines yet. But I'm wondering if I should start doing anything differently?

A. You raise an important issue relevant to millions of Americans, because type 2 diabetes damages blood vessels. In fact, this prediabetes phase is an absolutely critical time for you, especially because you have coronary artery disease. Almost everyone who gets type 2 diabetes passes through a prediabetes phase, when their glucose tests show modest, but worrisome, elevations, but their blood sugar readings aren't high enough to need oral diabetes drugs or insulin.

Drinking two cups of coffee a day may protect against heart failure, likely by lowering the risk of high blood pressure and diabetes.

Surgery beats stenting if you have diabetes and heart disease, too.

Both bypass surgery and its less invasive alternative, angioplasty plus stenting, are used to open severely narrowed coronary arteries. For most people, the two procedures have the same long-term benefits and risks. In people with diabetes, though, a new trial suggests that bypass surgery may be better than angioplasty plus stenting: it led to lower rates of heart attack and death over the next five years.

It's the first oral therapy approved for RA in more than 15 years.

Rheumatoid arthritis (RA) is much more common in women than men, and there is currently no cure or means of preventing the disease. However, in November 2012, the FDA approved a potent new treatment for people who have not had success with methotrexate (Rheumatrex), the standard initial therapy for RA symptoms. The new drug is tofacitinib (Xeljanz).

Sugar-sweetened beverages, whether caffeinated or decaffeinated, appear to be associated with higher risks of developing type 2 diabetes in both men and women. Coffee and tea appear to reduce the risk of developing type 2 diabetes.

Although diabetes increases the risk of heart attack in general, a variety of imaging tests may be used to further establish risk in an individual. 

A stress test can identify impaired blood flow to the heart (also known as ischemia) during exercise or stress. The greater the ischemia, the greater an individual's future risk of heart attack or death. "These people may be more likely to benefit from bypass surgery or stenting. Given the results of the FREEDOM trial, bypass surgery should be more strongly recommended for appropriate candidates with diabetes," says Dr. Ron Blankstein, a cardiologist specializing in preventive cardiology and cardiac imaging at Harvard-affiliated Brigham and Women's Hospital.

Protein-rich and high in vitamin D, the egg was once revered as an ideal food. Concerns over its high cholesterol content—210 milligrams (mg) in a large egg, almost all of it in the yolk—prompted some to question whether the risks of eating eggs might be greater than the benefit. The truth may lie somewhere in between. A new analysis of studies done on egg consumption and risk of heart attack or stroke came to the conclusion that eggs do not increase the risk of heart attack or stroke. In most of the studies included in the analysis, which was published on Jan. 16, 2013, in BMJ, participants ate up to 10 eggs per week; some ate 15 to 20. Yet no adverse effects were seen. The researchers concluded that it's safe to eat one egg a day. People with diabetes were an exception: their risk of heart disease rose along with the number of eggs eaten. In all people, though, eggs appeared to lower the risk of bleeding into the brain.

The American Heart Association recommends people consume no more than 300 mg of cholesterol a day. Considering the nutritional value and low cost of eggs, some experts suggest taking a wider look at food choices and trying to eat a diet that is low in cholesterol, rather than eliminating eggs.

Type 2 diabetes doesn’t usually appear all of a sudden. Many people have a long, slow, invisible lead-in to it called prediabetes. During this period, blood sugar levels are higher than normal. However, they’re not high enough to cause symptoms or to be classified as diabetes. It’s still possible at this stage to prevent the slide into full-blown diabetes. Think of prediabetes as a wake-up call. Unfortunately, few people ever hear the alarm. A new report from the Centers for Disease Control and Prevention shows that among Americans age 20 and older, only 10% of those with prediabetes know they have it. Given that as many as 73 million Americans have prediabetes, that’s a lot of missed opportunities to prevent the ravages of diabetes. One reason many people don’t know that they may be headed toward diabetes is they’ve never had their blood sugar tested. This simple test isn’t part of routine preventive care, but perhaps it should be.

Q. My doctor says my blood sugar is high, and that I may be at risk for prediabetes. What is prediabetes and how can I avoid it?

A. Prediabetes is a condition between normal health and full-blown diabetes, a condition that puts you at greater risk for developing diabetes. If you have been fasting for 8 hours or more, and you have a blood glucose (a kind of sugar) level of 100 to 125 mg/dL, you have prediabetes. If you have a level of 126 mg/dL or greater, you have full-blown diabetes. If you have prediabetes, particularly if your fasting blood glucose levels are in the upper part of the 100-125 mg/dL range, you are a considerably greater risk for developing the most common form of diabetes, type 2 diabetes. You can reduce your risk of getting both prediabetes and diabetes with the same strategies: regular moderate exercise and keeping a healthy weight. In fact, such lifestyle changes are more powerful in preventing diabetes or prediabetes than any medicine yet discovered. And regular moderate exercise—like 30 minutes of brisk walking at least 5 times a week—protects you against diabetes even if you don't lose weight.

If you can't do aerobics, weights can aid prevention.

You've probably heard that exercise helps to reduce the risk of type 2 diabetes. But you may assume that means you need to perform aerobic exercise that leads to weight loss, and that may seem daunting. Now a study from Harvard and the University of Southern Denmark says that men who do weight training instead can still significantly cut their diabetes risk. "It's great news for people who may not be able to do aerobic activity," says Dr. Eric Rimm, one of the authors of the study and an associate professor of epidemiology and nutrition at the Harvard School of Public Health.