Prediabetes. Are you at risk? Interview with Hope Warshaw, MMSc, RD, CDE

Hope WarshawHope Warshaw is a registered dietitian, certified diabetes educator and author of many books. We talked in Philadelphia at the annual Food and Nutrition Conference of the Academy of Nutrition and Dietetics about diabetes and prediabetes. This was our first of several interviews. (To see video, scroll to bottom or click here.)

Prediabetes video transcription

NeilyWe are talking about diabetes—prediabetes in particular. So let’s talk   statistics.
Hope:Sure. To frame this for people, about 80 million people in the United States are thought to have prediabetes.
Neily:That’s prediabetes and not diabetes. Right?
Hope:Right. That’s prediabetes. It’s not diabetes. We know about 26 million people have diabetes, either type 1 or type 2. And that’s not pregnancy (gestational) diabetes.
Hope:I think a critical number that people need to know is that only about 10% of that 80 million people know they have prediabetes. That’s an important message if people have a family history of type 2 diabetes, if they are overweight, or if they feel like they have other risk factors for type 2. Don’t wait for your physician or your primary care provider to say this.
Neily:And a lot of people don’t even go to a physician regularly.
Hope:That’s right. I would recommend that people go to the American Diabetes Association Risk Test… or just search on diabetes risk test. That takes about 30 seconds. And you can just get a gauge. It’s not going to diagnose but it’s going to help you think about whether you may have prediabetes. What I think is so critical and why I think it’s so critical that people know this is that the time to take action is as early as possible. What we know from many studies about prediabetes across the globe is that the sooner you take action losing a small amount of weight can help delay the progression of the onset of type 2 diabetes. People   don’t have in their mind that diabetes is a progressive disease.
Hope:They don’t know that it’s a progressive disease. And we know that at the point that people are diagnosed with type 2 diabetes, they have already lost 50% to 80% of their insulin-making capacity. Function cells—we don’t totally know exactly which, but they’re already far down the road. And what we know from studies is that losing 5 to 7 percent of body weight—that’s 10 to 20 pounds from your starting weight—and working hard to keep as much off as you can, can definitely delay the progression of type 2 diabetes. I hear stories every day of people losing some weight, making those critical eating habit and exercise behavior changes. And not only reversing their road with diabetes but making   changes in a myriad of other health disorders. Losing that amount of weight has been shown to decrease sleep apnea, decrease risk for some cancers. So that little bit of weight loss has incredible power.
Neily:Now, to define prediabetes, it’s a fasting blood sugar of 100 to 125. And then also you were saying the A1c, which is a measure of average of blood sugar over…
Hope:Two to three months.
Neily:That number should be?
HopeSo the prediabetes number is if A1c is greater than 5.7 and less than 6.4. It’s a percent and it’s like a videotape of the last two to three months of all the ups and downs of your blood sugar. And since 2010, that has been sort of okayed as a diagnostic measure of diabetes and prediabetes. But you can’t expect that necessarily the primary care providers know about or think about measuring an A1c.
Hope:You know, so often our medical people are in sort of crisis handling mode…and don’t have a prevention mindset. More and more do. And I’m not taking anything away—they have a lot to manage. So I do believe that people who may be at risk need to be their own best advocate.
Neily:Excellent. So checking out or just a risk assessment for prediabetes and taking action, losing weight…
Hope:Right. It’s not about going on a diet.
Neily:No, no.
Hope:Or finding the latest, greatest fad diet. It’s about simple changes.
Neily:You want to lose that weight and keep it off.
Neily:That’s the most critical thing. Okay, great. And we’ll talk more about some other things in another video but excellent information. Prediabetes is definitely on the rise and only will continue to be.
Hope:It’s a wow.
Neily:Yes, it is a big wow. Thanks so much, Hope! This is Neily on Nutrition and we’ll see you in the next video. Hope’s website is



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