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Diabetes Update: Pre-Diabetes

Number 34; April 1, 2002

By David Mendosa


This newsletter keeps you up-to-date with new articles, columns, and Web pages that I have written. I list and link most of these on my Diabetes Directory at www.mendosa.com/diabetes.htm

From time to time Diabetes Update may also include links to other Web pages of special interest.

My most recent contribution is:

on April 1, 2002
Diabetic Retinopathy
The complications of diabetes are probably the last thing any of us want to hear about. And of all the complications the threat of blindness is one of the scariest. Yet here I am reviewing a site about diabetic retinopathy. Why? Because it is a fascinating case study that is so well done that it successfully targets both professionals and people with diabetes. Besides, the emphasis is positive, focusing on rehabilitation. The URL is
http://www.diabetes.org/main/community/info_news/web/default.jsp

Update:

on March 30, 2002
Coconuts
Recently, several people have asked me about the glycemic index of coconut. I had no idea what the GI of coconut was until I looked into it.

Remember, the GI measures how fast the available carbohydrates in the food raise blood sugar. By available carbohydrates I mean (as explained on my GI page) the total carbohydrates minus the fiber. That's because while we count fiber as carbohydrates (in this country), they have no effect on blood sugar.

So, look at the composition of coconut and coconut milk at http://www.nal.usda.gov/fnic/cgi-bin/nut_search.pl :

It finds 32 types. For example, 100 grams of Nuts, coconut meat, raw is mostly fat—33 grams. It has a bit of protein, 3 grams, and only 6 grams of available carbohydrate (carbohydrate minus fiber).

Similarly, with 100 grams of Nuts, coconut milk, raw (liquid expressed from grated meat and water). It has 24 grams of fat, 2 grams of protein, and 3 grams of carbohydrate.

These numbers would put coconut and coconut milk within the range of those products that are not feasible to test—since they have to test 50 grams of available carbohydrate. That would mean, for example, that the test subjects would have to drink 3333 grams of the stuff, which is too much to ask of anyone!

All the fat in the coconut will also slow down any blood sugar rise that the carbohydrates might provide. Therefore, I would have to conclude that the GI of coconut and coconut milk has to be quite low.

Announcement:

on March 27, 2002
"Pre-Diabetes" Replaces "Impaired Glucose Tolerance"
Nearly 16 million Americans have pre-diabetes, a condition which didn't exist before last week. At least it didn't have a name. They used to call it impaired glucose tolerance, but an expert panel renamed it, according to a joint ADA/U.S. Department of Health and Human Services press release March 27.

The term described people who have blood sugar readings above normal but not yet high enough to diagnose type 2 diabetes. The term is not applicable to type 1 diabetes.

The old term "Impaired Glucose Tolerance," is a condition in which the blood glucose level is elevated (between 140 and 199 milligrams per deciliter or mg/dl in a 2-hour oral glucose tolerance test), but is not high enough to be classified as diabetes, according to the NIDDK's National Diabetes Statistics. "Among U.S. adults 40 to 74 years of age, 16 million...have IGT," this government site says. That has to be the basis of the estimate of nearly 16 million Americans who have pre-diabetes.

What about the other pre-diabetic condition? Impaired Fasting Glucose (IFG) is also considered to be a prediabetic condition, according to the same site. "IFG is a condition in which the fasting blood glucose level is elevated (between 110 and 125 mg/dl after an overnight fast) but is not high enough to be classified as diabetes." It says that 10 million Americans have IFG.

It looks to me like the new definition of pre-diabetes that 16 million people have is saying that those with IFG comprise a sub-set of those with IGT. But I wonder if the overlap is complete.

The panel also called for overweight people age 45 and older to be screened for pre-diabetes, if they have one or more additional risk factors. The new terminology was "to help lay the groundwork for the translation of the new ADA/NIDDK Position Paper entitled 'The Prevention or Delay of Type 2 Diabetes,' which will appear in the April 2002 issue of Diabetes Care," according to an announcement sent to members of American Association of Diabetes Educators. However, the new position paper, which is already on-line at http://care.diabetesjournals.org/cgi/content/full/25/4/742, does not use the new terminology.

In addition, HHS Secretary Tommy G. Thompson released an updated HHS estimate showing 17 million Americans have diabetes. The new number is already on the NIDDK site, showing 11.1 million people diagnosed and 5.9 million undiagnosed. The previous estimate was 15.7 million people, of which 10.3 million people were diagnosed and 5.4 million people were undiagnosed.

The new estimate is based on population changes in the most recent U.S. census, the press release says. For some reason that I don't understand the new estimates don't consider statistics recently published in Diabetes Care.

Scientists from two divisions of the U.S. government's Centers for Disease Control and Prevention in Atlanta recently collaborated on an article entitled "Diabetes Trends in the U.S.: 1990-1998." This article, published in Diabetes Care 2000 Sept;23(9):1278-1283, found that the prevalence of diagnosed diabetes increased by 33 percent nationally during this time, reaching 6.5 percent of those over 18 in 1998.

CDC scientists updated this information in a letter to the editor entitled, "The Continuing Increase of Diabetes in the U.S.," which was published in Diabetes Care 2001 Feb;24(2):412. This letter reported that the prevalence of diabetes increased to 6.9 percent of Americans over 18 in 1999.

Neither report says how many people that is. But U.S. Census Bureau data say the country's population was 276,059,000 in 2000, of which 205,575,000 were over 18. If 6.9 percent have diagnosed diabetes, the number is 14.18 million—a considerable increase over the old 10.3 million figure and new 11.1 million estimate.

This does not include Americans under 18. According to the Juvenile Diabetes Foundation International there are approximately 127,000 children younger than 19 who have diabetes, almost all of whom have type 1. That would bring the total of Americans with diagnosed diabetes to 14.3 million.

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