June 2, 2025 • 34 mins
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Prediabetes affects over one-third of Americans, yet 80% don't know they have it. We break down what this silent condition means for your health and provide practical strategies to prevent progression to diabetes.
• Prediabetes is defined as blood sugar that's elevated but not high enough to be diabetes
• Risk factors include being over 45, overweight, family history of diabetes, and certain racial backgrounds
• Prediabetes independently increases risk for heart disease, stroke, and kidney disease
• Losing just 7% of body weight and exercising 150 minutes weekly reduces diabetes risk by 58%
• Even without weight loss, exercise alone cuts diabetes risk by 44%
• Focus on whole foods, legumes, fruits, vegetables, and limiting processed foods
• Poor sleep significantly increases diabetes risk—aim for 7-8 hours of quality sleep
• Metformin may be recommended for higher-risk individuals
• Prediabetes is reversible with lifestyle changes
Follow our podcast and share this episode with a loved one—since one-third of Americans have prediabetes and most don't know it, you could help someone take control of their health before it's too late.
Production and Content: Edward Delesky, MD & Nicole Aruffo, RN
Artwork: Olivia Pawlowski
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:07):
Hi, welcome to your checkup.
We are the patient educationpodcast, where we bring
conversations from the doctor'soffice to your ears.
On this podcast, we try tobring medicine closer to its
patients.
I'm Ed Dolesky, a familymedicine doctor in the
Philadelphia area, and I'mNicola Rufo.
I'm a nurse and we are soexcited you were able to join us
here again today.
So we're recording from a veryspecial location, with a
(00:28):
quasi-live audience staring atus here, who is not just our
intern.
Yeah, we have our intern, who'salso accompanied by let's see,
does she have a title Our HBICyes, by the HBIC, and a crow
upstairs who is not watching.
We're driving down the.
(00:49):
We have a live audience.
We do this is the first timewe've had a live audience.
This is quite the honor andwe're just looking forward to
putting together a great episodehere today.
I hope this isn't so echoeythat this is prohibitive.
Speaker 2 (01:03):
Well, I guess we'll find out.
Speaker 1 (01:05):
We're going to find out.
So we're driving down thehighway and we see a large
bulletin board.
A bulletin board, what is it?
Billboard, Billboard thank you.
Speaker 2 (01:17):
A live audience already contributed.
Speaker 1 (01:19):
We see a live billboard that says give space
to the seals.
Why do seals need space?
Speaker 2 (01:27):
We all need space.
I feel like I relate to theseals sometimes.
Speaker 1 (01:31):
You needed space earlier today.
Speaker 2 (01:33):
Yeah, I did.
Yeah, what about it?
Speaker 1 (01:37):
Well, if anyone out there knows why seals need space
if they thrash about and offer.
Speaker 2 (01:43):
They might.
They might be aggressive validthat they're sunning on the
beach, yeah, our live audienceyeah yeah, perhaps that's it.
Speaker 1 (01:56):
Well, if anyone out there has any better idea about
why seals might need space,please let us know.
And maybe they're sunning onthe beach.
My second point I wanted toraise today is the movie Nonas.
Speaker 2 (02:07):
Oh yeah.
Speaker 1 (02:09):
What a wholesome movie on Netflix.
If you haven't seen it, gocheck it out.
Vince Vaughn is this guy whosemother passes away, and Oteca
Maria right, I think that's hername and he makes a restaurant
in her name as an homage tohonor her and her Italian
recipes, and he hires Nona's tobe the chefs.
(02:32):
It is an incredible movie.
Speaker 2 (02:34):
And he feels seen, he feels that his culture is
represented on TV.
Speaker 1 (02:40):
Finally, my upbringing as an Italian
grandmother has finally beenrecognized.
No, but truthfully, I thinkthey did an excellent job of
really putting these women tothe forefront and celebrating
them, and it was a great,wholesome, family-friendly movie
he may or may not have tearedup at the end, wouldn't you?
(03:02):
it was so beautiful he wasgetting right.
Well, I don't want to spoil itfor anyone, but I it was.
It was an amazing movie andwell, they said all the like,
the hot phrases, like they saidI mean like maroon, or that's a
sin, or like, or they talk aboutthis, like what was it?
The, the head of the, the beast, that they said the capuzel,
(03:23):
but what is?
What was the animal?
Speaker 2 (03:26):
um a sheep head a sheep head.
Speaker 1 (03:28):
Yeah, yeah, and apparently you can go to this
restaurant based on a true storyand we can talk about the true
story thing that I've hadotherwise.
Um well, I didn't know that theblind side was a true story are
you for real?
Yeah, I think when did you?
Speaker 2 (03:43):
learn this.
You didn't know.
Speaker 1 (03:46):
No, no, no.
It was only after watching themovie that it became apparent to
me, but I went the whole movieexperience thinking it was a
fictional movie.
Speaker 2 (03:54):
Oh.
Speaker 1 (03:56):
Sandra Bullock.
Speaker 2 (03:57):
Yes.
Speaker 1 (03:58):
Yeah, so that was real Unbeknownst to me.
I've known it since the moviecame out, though oh, okay yeah
that's less offensive uh, do youhave any takeaways from this
week of anything that you werehoping to talk about a little?
Speaker 2 (04:18):
bit.
Do we need to talk about yourtoilet incident last?
Speaker 1 (04:22):
night.
Why don't we?
Why don't we?
Why don't we do it?
Why don't I see how, how I feelthis was an outrageous thing.
We, you know it's not every dayyou go to the bathroom and
sometimes you, like you, havedifferent experiences.
Some are loose, some are loose,some are live audience members
(04:44):
saying you don't questioning.
Like you don't go to thebathroom every day, you know if
you have a busy morning andyou're running out sometimes you
suffer from occasionalconstipation.
Yeah, and we have an episode onthat right and you can go listen
to that if you want.
So you know I'm doing mybusiness.
We have the squatty potty.
If you haven't heard orunderstand that we do that, we
have a, a travel one.
So I'm like hanging out withthe travel squatty potty and,
(05:08):
like you know, it's a larger one, the girth is bigger than
normal and I understood that onthe way out and I give it one
flush and the water is a littleslow to go down and so I think,
ah, maybe it needs a little bitmore flow to kind of break it up
.
So I give it a second flush andthe water level rises in the
(05:30):
toilet.
And now I'm an idiot becauseI'm looking at it and I'm like a
third will do it.
Third time's the charm.
So now the bathroom door's open, nikki comes up and she's
looking around and you come intowhat.
What do you see like?
Speaker 2 (05:47):
from your perspective , it was probably one of the
funniest things I've ever seen.
He's hunched over the toiletwith like the toilet seat up and
the water's overflowing nowit's overflowing now it's
overflowing, it's all over thefloor.
My parents are downstairs andhe's like this is so bad, this
is so bad, I need it.
(06:07):
Do you have the plunger?
Do you have the thing?
I need it.
Now he's like don't tell them,don't tell them.
So I run down the stairs andI'm like eddie clogged the
toilet.
I need the plunger.
Where is it?
Speaker 1 (06:19):
and and you're like do you need me to go get?
Like, like, go get my dad.
Like, do you need me to go?
No, do not.
Do not go get him.
No, I need to fix this, do not.
And it takes it's about fiveminutes and we're right at the
cusp.
The water is at the top of thetoilet, and then we hear from
(06:41):
Mary downstairs and she's likejust click the button in the
reservoir and the water will godown.
So then you come in, thank youfor saving the day.
You click the button and thewater starts coming in again.
Yeah, and now we're gettingeven higher and higher and I'm
like oh, we're overflowing again.
Now the towels are on the floor.
I think it was a very cleanthing.
The turd was like down thepipes already, like this was a
(07:07):
downstream obstruction and Godbless, if this makes it like
live to the episode.
I mean this is gonna be crazy.
Eventually it worked out andthe plumbing works and that was
a beautiful thing that happened.
Speaker 2 (07:15):
It was yeah it was, I think.
Yeah, that's that, oh man.
Speaker 1 (07:27):
How do you feel Anything else?
You want to talk about.
I think that was.
I don't think so it's aboutseven minutes.
Oh yeah, wait.
And so then you come back andI'm like can you get like a wire
hanger or anything?
And I'm like I need, like Ineed a wire hanger, and I'm like
I need something metal.
And she's okay, let me go look.
So she comes back and she'slike we only have this.
And she comes back with aroutine plastic coat hanger.
Speaker 2 (07:51):
Okay, we're not a wire hanger family, we're a felt
hanger family and a couplerogue plastic ones.
Speaker 1 (07:59):
And I'm like why did you bring that?
And she's like this is all wehad.
And she's like this is all wehad.
It's not a comedy podcast, butI hope that you get some jokes
out of it every once in a while.
This is a good opener, goodenergy, live audience.
Speaker 2 (08:17):
I hope Mike laughs at this when he's in his basement
doing basement things.
Speaker 1 (08:21):
I can't believe that potential future patients of
mine listen to this and maybethey'll get a sense of my
character and bowel habits,hopefully, all right.
You ready?
Yeah, all right.
What are we going to talk abouttoday, nick?
Speaker 2 (08:35):
Today we're talking about pre-diabetes.
Speaker 1 (08:38):
Yeah, this is such an important episode and I really
want to call light that thisepisode fills the gap in this
type of situation.
You went to the doctor, you hada nice visit with them, they
decided to get some labs and hesaid I'm just going to get some
labs to do some metabolicstudies and then you get the
results back and they give youtheir interpretation.
(09:00):
And they give you a little oneline or you see a little thing
like hemoglobin a1c 5.8, andthey send you a message and they
say sorry, we detected that youhave pre-diabetes.
Good luck, do some diet andexercise and see you later.
This episode, I hope, fillsthis gap because that is such a
(09:23):
common thing that happens.
This whole thing is so common,in fact, that it's estimated.
Because there's a thing here isthat it's estimated that more
than 96 million Americans thatis, over one third, one in three
people, have prediabetes and asmany as 80% of people don't
(09:45):
know they have it.
Let's sit with that for a secondDone done, done, done, done,
done, but really like people arefloating around out here with
pre-diabetes not knowing it.
Now this wasn't a thing likeforever, like when I was in med
school.
Some doctors were likepre-diabetes wasn't a thing back
in my day, but it is now.
(10:06):
So that's why we're going totalk about it here today.
So pre-diabetes doesn't onlyincrease the risk for getting
diabetes itself.
It independently has risks forheart disease, stroke and kidney
disease.
And so today we're going toinform you and empower you with
facts, tools and hopefully, bythe end of it, some hope.
(10:27):
Nikki, can you take us throughand tell us what is prediabetes?
Speaker 2 (10:36):
Prediabetes is?
The explanation is prettysimple it's when our blood sugar
is elevated, so it's high, butit's not high enough to call it
diabetes.
Speaker 1 (10:46):
To capture the diagnosis of prediabetes.
The American DiabetesAssociation in 2025 says that
you need a fasting plasmaglucose.
What does that mean?
You haven't eaten in eighthours and you got your blood
work done and you have a bloodsugar between 100 and 125
milligrams per deciliter.
And I have to correct myself,because we have an international
(11:08):
audience, that that is not themillimole number, so that's just
the American standard numbersreported.
You can have a two hour oralglucose tolerance test, which is
less common because it's kindof cumbersome.
You have to drink a glucosesolution and then get your blood
sugar measured two hours later.
But if you do that and yourblood sugar is measured between
(11:29):
140 and 199 milligrams perdeciliter, they call that
impaired glucose tolerance, asopposed to impaired fasting
glucose, which is a differentstory.
And most commonly, I would say,comes up the hemoglobin A1C,
which will restate is that threemonth average of your blood
(11:50):
sugar that you know when bloodsugar plucks on your red blood
cells.
The lifespan of a red bloodcell is about 90 days or three
months, so it's like the threemonth report card of your blood
sugar and if that level isbetween 5.7 and 6.4%, that is
pre-diabetes and it's importantto know that many people feel
(12:11):
totally fine, they don't feelsick, and that's why this is
kind of like a yellow flag, asilent warning that happens.
So, nikki, we talked about likethe diagnosis and how you
capture that, but who is at riskfor pre-diabetes?
Speaker 2 (12:24):
about, like the diagnosis and how you capture
that.
But who is at risk forprediabetes?
So people who are 45 years orover, um, anyone who's
overweight or obese, so with aBMI of over 25 or 23.
For Asian Americans, familyhistory of diabetes, low
physical activity, any historyof gestational diabetes or PCOS,
(12:45):
high blood pressure, and thencertain racial groups.
So black, Hispanic, NativeAmericans, Asian American and
Pacific Islanders are more atrisk.
Speaker 1 (12:58):
Yep, and there are certain tools available, like
the American DiabetesAssociation has a risk test.
So this is a simple onlineself-screening tool and
truthfully like, if you could.
I think there are differentguidelines from different groups
that make these guidelines,like the USPSTF or American
Diabetes Association havedifferent opinions about who
(13:21):
should get screened, soessentially, you should ask your
doctor about what the rightplan is for you.
Speaker 2 (13:28):
So before we get into what we can do about
prediabetes, let's talk aboutwhy it's important.
Speaker 1 (13:36):
This is going to be a bigger conversation, so kind of
buckle in for this one.
The risk of diabetes issomething I want to spend more
time on, so I'm going to startwith the other ones.
Prediabetes itself has beendescribed in the literature that
there is an increased risk,independently of anything else,
of heart attack, stroke andchronic kidney disease just by
(13:59):
having prediabetes.
So that in and of itself makesit important enough to pay
attention to.
And oftentimes people when theyhave prediabetes also may have
hypertension or they may havedyslipidemia or otherwise
abnormal cholesterol levels andthey may have central obesity,
(14:20):
which that visceral fat, thatfat that lives around the belly
is worse than compared to othertypes of obesity and subtypes.
So then the big question comesof I have prediabetes not me,
but someone, like a supposition,saying like I have prediabetes,
what does that mean for me?
(14:41):
So there's a lot of literaturethat says that the annual
progression that there's aboutlike a five to 10% risk every
year of developing diabetes whenyou have prediabetes.
There are European studies thattry to estimate lifetime risks,
but you can imagine that that'sa little tricky because someone
(15:02):
may be 20 with prediabetes andthen you might have someone who
is 70 who discovers that theyhave prediabetes, and those two
people are in different riskgroups.
So there's a European studythat states that the lifetime
risk of developing type 2diabetes for someone with
(15:22):
prediabetes is 74% and that'spretty high.
But I think that that doesn'treally totally like calculate
that, like someone who's 20years old has like an 88% chance
of developing diabetes if theyhave prediabetes.
So to sort of round that up andsummarize it, if you have
(15:42):
prediabetes every year there'sabout a 10% chance of developing
diabetes and in a lifetimethere are lots of different
studies and it matters how oldyou are, but it could be 74%,
could be as high as 88% in thelifetime if you don't take
action to prevent that now.
Does that invoke any feelingsor thoughts?
(16:03):
Did you know that like off thedome or?
I mean not those specificnumbers, but I feel like that's
important to know, because Ifeel like people are told they
have pre-diabetes and thenthey're just like, oh well, I
don't have diabetes right and itmatters, like they we're going
to talk about like medicines inthe like later parts of the
(16:25):
episode, but like there are highrisk pre-diabetes groups, like
if you're over six or you'reyounger that's a much higher
risk, or your BMI is over 35.
Like much higher risk ofdeveloping diabetes than someone
without those things.
I'm going to save a little bitof that conversation for after,
but that's sort of why this isimportant Because it affects
(16:48):
your heart health.
Stroke risk, chronic kidneydisease risk and overall the
risk of developing diabetes issignificant.
So why don't we take a littlebit of time after being a little
doom and gloom of like oh mygosh, I have prediabetes?
You probably now have thoughtmore about prediabetes if you're
making it this long through theepisode than you ever have
(17:09):
before.
Prediabetes if you're making itthis long through the episode
than you ever have before.
But what can we do to preventprogression to diabetes and kind
of manage those other riskfactors?
Speaker 2 (17:21):
There are a lot of things that we can do, and we
actually have multiple episodeson all of these things, and
that's because, well, medicationaside, all of them are
lifestyle changes, which are thecornerstone of prevention.
Speaker 1 (17:38):
Totally so.
These um, this data isn't justpulled out of thin air.
There were massive studies thatwere done and continue to be
done.
But a lot of this data that I'mgoing to say next comes from a
very large study called theDiabetes Prevention Program and
that showed and I'm going togive you very specific numbers
here, because I think when wetalk about goals we like to have
(18:01):
something like a smart goal andthis falls under the S of that
specific Losing just 7% of yourbody weight and entertaining or
doing 150 minutes of moderateintensity exercise a week
reduced the risk of diabetes by58% Just those things.
(18:23):
So a 7% weight loss is that canbe challenging to get, but it's
not insurmountable and we cantalk about how they did that,
but that's what they found.
That study was done over thecourse of three years, so
(18:46):
there's like a little bit of alimit to that.
And another piece is that youeven get some benefit even if
you don't lose weight and youjust exercise.
They also looked at people whodidn't lose weight and they just
did physical activity goals andthat cut the risk of diabetes
by 44%.
So even if you're just movingand you don't lose any weight,
it's still worthwhile to doexercise, and we've talked about
(19:06):
why exercise is so important,beyond weight loss or anything
else like improving your sleep,improving your mood, your
cognition.
Now here's another reason.
So what else they did?
How do you like?
We've talked a little bit aboutthis in other episodes, but to
kind of like talk about how theylost weight in this study was
(19:27):
they looked at the amount ofcalories that it took someone to
stay the same weight and theyfound that out, just like in
their diet, tracking what theyate.
And then they subtracted 500 toa thousand calories a day.
And then they act.
They went for 700 calories aday of physical movement, and so
(19:48):
in creating that, they wereable to induce this calorie
deficit and help people losetheir weight.
And because so we have aquestion from our audience here
of what does 700 calories looklike?
And because that's achallenging thing to capture,
they translated that into 150minutes of moderate intensity
(20:10):
exercise a week.
Oh yeah, and so otherwise thattranslates into 30 minutes five
times a week.
And to the weight loss end,since we were talking about that
a little bit, there also wasevidence from the diabetes
prevention program, that said,for every kilogram of weight
lost.
So for our overseas folks,congratulations.
(20:30):
We're using the metric system.
For those in the United Statesit's about two pounds.
For every two pounds lost,there is a 16% reduction in
transition to diabetes over thecourse of the three years.
Just to give you a little bitmore, and they saw more was
better in terms of like 10%.
If you lost 10% of your bodyweight, great, even more benefit
(20:52):
, less risk of developingdiabetes.
So we talked about weight loss,we talked about physical
activity and their role inreducing the risk of going to
diabetes.
What about nutrition?
What certain things should wethink about here, or what
(21:12):
opportunities are there forpeople to have their improvement
?
So in the study for thediabetes prevention program,
they found that no single idealmacronutrient distribution
worked.
What the heck does that mean?
No amount of carbs compared toprotein compared to fat actually
made a heck of a difference forpreventing diabetes, and it has
to be personal for thatindividual.
(21:34):
But there are some effectiveeating patterns that are very
well known to help preventdiabetes, and these include the
Mediterranean diet.
Certain low-carb diets andplant-based or the DASH diet are
well known to help preventtransition from prediabetes to
diabetes, and the key piece ofthis knowing is that you really
(21:57):
just have to find what works foryou, and so there are certain
foods that we can emphasize.
Nikki, can you take us throughwhat foods, like we did on our
prior episode, what foods toemphasize and then what things
we might be able to minimize aswe think about food and the
nature of preventing diabetes?
well, we want to emphasize wholegrains, nuts, fruits,
(22:20):
vegetables and our favoritelegumes and I'm not legume or
legume Anyway, and what sorts ofthings should we try to limit?
Speaker 2 (22:34):
We're trying to limit refined and processed foods.
Speaker 1 (22:38):
Yeah, also high in sodium oftentimes, and so for
those people out there trying towatch their hypertension, that
might not be helpful.
There are certain like scores Iwas looking up like there's the
healthy eating index, thealternative healthy eating index
and the dash score are allresources that you can look up
online and kind of measure howgood a food is if you're curious
(22:59):
.
And, honestly, this is a greattime for a dietitian to step in
and help educate people Because,as you know, here, like, we're
listing a bunch of foods but wedon't talk about portion sizes,
we don't talk about, like eatingthroughout the day and how to
manage that, and, honestly,they're so talented and it's a
whole specialty in and of itselfthat gets its whole education.
(23:20):
So we're not going to pretendlike this is the be all end, all
education, but it's somethingthat you should think about
because it's very important.
Something else when it comes tonow we've talked about three
things.
We've talked about weight loss,physical activity and nutrition
, and the guidelines from theADA specifically call out sleep
(23:41):
in this year's recommendationsfor preventing prediabetes and
they now recognize that poorsleep is a key contributor of
preventing diabetes, that poorsleep is a key contributor of
preventing diabetes.
They highlight sleep less thansix hours or greater than nine
hours linked to a 50% increasedrisk of diabetes.
Speaker 2 (24:00):
We have to get rid of those blackout curtains here.
I know you sleep like ateenager down here.
Speaker 1 (24:07):
Totally yeah.
I'm like a cozy boy in themorning.
I just don't want to get up atall.
Speaker 2 (24:14):
And then increasing your risk of diabetes by
sleeping more than nine hours.
I know I didn't sleep more thannine hours last night.
Speaker 1 (24:21):
And then they said that poor sleep quality is
linked to about 40 to 84%increased risk.
That's a big broad range, sowe'll keep it light there, but
really you should think aboutsleep hygiene.
We have an episode on that, andstress reduction can be a
really important part ofpreventing diabetes.
So all those four things thatwe talked about are all things
(24:42):
that you can start doing at homewithout a doctor.
You just get outside, startstart exercising, maybe get a
gym membership, or find someonein your family, go for a walk
after dinner.
Whatever it is.
You can get started today.
You don't have to wait.
Speaker 2 (25:02):
Exercise, eat well and don't watch reality TV
before bed, so you can sleep.
Speaker 1 (25:09):
That's a crazy thing.
Speaker 2 (25:11):
It's actually so annoying, yeah like I know we
talk about like sleep hygieneand all the things that you can
do, blah, blah, blah.
We have a whole episode we bothlike.
Two nights this week we watchedtv in bed before we went to
sleep.
Both couldn't sleep.
And then the following twonights we didn't look at our
phones and didn't watch TVbefore bed and we slept the
(25:32):
entire night.
Yep Didn't wake up until ouralarms went off.
So annoying.
Speaker 1 (25:37):
It was so annoying.
And now we just watch our TVdownstairs and then when we go
upstairs we just don't, becauseyou got the whole projector
thing and it's nice, it's likebig.
Speaker 2 (25:45):
Yeah, it's entertaining.
And our king bed In our kingbed, I know it's a premium TV
experience.
Yeah, it's a sin.
Speaker 1 (25:57):
So we spent a lot of time talking about lifestyle
changes for prevention ofdiabetes and we want to take
(26:20):
some time to talk about when wethink medication might help,
because the American DiabetesAssociation does highlight
certain times where it can behelpful.
So metformin ends up being themost studied and safest
medication used to helppre-diabetes or to prevent
progression to diabetes whensomeone has pre-diabetes.
It also happens to be one ofthe most common first line
treatments of diabetes as well.
And, nikki, can you take usthrough a little bit of what
(26:40):
makes someone higher risk, whenthey have prediabetes, of
progressing to diabetes?
We teased at them before, butcan we say them out loud so
everyone knows?
We teased at them before, butcan?
Speaker 2 (26:51):
we say them out loud so everyone knows.
Speaker 1 (26:52):
So people who are 25 to 59 years old, have a BMI
equal or greater than 35, havean A1C of 6% or higher or a
history of gestational diabetesno-transcript equal, and so it's
(27:37):
a personal choice.
But that's just some of thedata that we have and truthfully
, we listed those parameters.
But metformin is more effectivein younger adults and those who
have obesity.
A little note on metformin foranyone listening long-term
metformin use can lead to B12deficiency and deserves periodic
screening of that lab.
(27:58):
Usually that increases withtime and the higher risk is seen
four to five years aftertreatment.
We I mean we have a lot ofepisodes and we'll have more
episodes in the future aboutother medications to help
prevent diabetes.
All of the medications thathelp people lose weight by way
of accomplishing that weightloss of at least 7%, help reduce
(28:20):
the risk of progression todiabetes.
But these include medicineslike semaglutide, liraglutide
orlistat, which really isn'tused much anymore, liraglutide
orlistat, which really isn'tused much anymore, phentermine,
topiramate and the big gun,terzepatide, otherwise called
Zepbound or Moonjaro, and theyshow benefit very clearly.
(28:41):
We don't have data for youright off the top, but I was
listening to other podcastsrecently that was quoting from
experts like 95% reduction withthe GLP-1 agonists in
progression to diabetes, butunfortunately these aren't fda
approved for specifically theprevention of diabetes and,
honestly, are really not coveredby insurance often for these
(29:02):
specific indications at all, andso metformin remains the
easiest, most accessible, mostaffordable medication that could
be used and leaves room forconversation with your doctor as
we kind of get to the tail endof the episode here.
I really wanted to highlight theopportunity to reduce
cardiovascular risk when peoplehave prediabetes.
(29:25):
Now that's an additional riskfactor and oftentimes, like we
said before, people usually haveproblems with their blood
pressure at this point.
They have problems withcholesterol oftentimes, and if
someone's smoking, it is like apeak time to really stop smoking
, because that is the worst ofall for cardiovascular risk
reduction.
And if you were to really combthrough the American Diabetes
(29:46):
Association guidelines and Ithink I might be opening a can
of worms here, becauseapparently statins are a hot
button topic what they found inthe diabetes prevention program
was that the statin wasassociated with a greater
diabetes risk.
So it's real, it'sstatistically significant that
(30:06):
they do slightly increase therisk of diabetes and tipping
people over the edge when theyhave prediabetes.
And so then they took thatinformation and they compared
that fact of knowing that thishappens and compared it against
the benefit that statins have atreducing cardiovascular
(30:26):
mortality and death, and thebenefit of reduction in
mortality is still greater thanthe slight increased risk of
diabetes onset.
And so, then, theirrecommendation is that you
should still use the statin andyou shouldn't stop the statin if
this happens, which is a trickything because for some reason,
(30:52):
they're such a hot button topic.
Speaker 2 (30:53):
People love to come for the statin.
They do.
Speaker 1 (30:56):
They're like one of the best medicines out there.
So weird, the best medicines wehave and people love to come
after them.
For some reason, and likeanytime we're being active
online like this is the medicinethat by far gets the most hate
of any of them and it's justcrazy.
So, overall, the AmericanDiabetes Association says
(31:17):
discontinuation of statins dueto concerns of diabetes risk is
not recommended for people withprediabetes, which is a very
nuanced thing that like I don'tknow anyone who would take the
time in an office visit toexplain.
So then you get the peopleonline with the, the highlights
saying like statins causediabetes.
Speaker 2 (31:37):
Yeah, but like causing something and slightly
increasing a risk for somethingare very different when, like,
they knowingly already decreasethe risk of death.
Speaker 1 (31:46):
Yeah, making people live longer.
So so, when it comes topreventing pre-diabetes, we
talked a lot today and we talkeda lot today about, like, why is
important what you can do toprevent it?
Uh, I mean, the cdc is in fluxin terms of how much we can
trust their information withcurrent administration changes
(32:07):
and the department of health andHuman Services.
But there are programs.
There are diabetes preventionprograms that you can go out and
ask your doctor for.
In the community.
You can get some advice.
Dieticians are out there and goexercise.
Go out there, do whatever yougot to do to be able to help
prevent diabetes.
(32:30):
So we have some closing thoughts.
They are that pre-diabetes isreversible, but you really do
have to take action and yourhealth is worth the investment
and even the small steps thatyou take really do matter.
So three things to think aboutare to ask your doctor if they
think you should have your A1Cchecked.
A brisk walk counts.
So move your body and try toeat more whole foods and watch
(32:53):
your portion sizes and don'tsnack.
So thank you for coming back toanother episode of your Checkup
.
Hopefully today you were ableto learn something for yourself,
a loved one or a neighbor withprediabetes.
Feel free to check out ourwebsite, send us an email if you
felt like you wanted to talk tous about this episode, and my
one call to action for you is tofollow the podcast so that you
(33:15):
can see when our next episodecomes out and, if you're really
willing to take a step further,share it with a loved one or a
neighbor so that, because onethird of them have prediabetes
and they don't probably don'tknow it, so maybe they'll get
something out of this episode.
Most importantly, stay healthy,my friends, until next time.
I'm Ed Dolesky.
Speaker 2 (33:33):
I'm Nicole Rufo.
Speaker 1 (33:34):
Thank you and goodbye .
Speaker 2 (33:36):
Bye.
Speaker 1 (33:39):
This information may provide a brief overview of
diagnosis, treatment andmedications.
It's not exhaustive and is atool to help you understand
potential options about yourhealth.
It doesn't cover all detailsabout conditions, treatments or
medications for a specificperson.
This is not medical advice oran attempt to substitute medical
advice.
You should contact a healthcareprovider for personalized
guidance based on your uniquecircumstances.
(34:01):
We explicitly disclaim anyliability relating to the
information given or its use.
This content doesn't endorseany treatments or medications
for a specific patient.
Always talk to your healthcareprovider for complete
information tailored to you.
In short, I'm not your doctor,I am not your nurse, and make
sure you go get your own checkupwith your own personal doctor.
Hi, welcome to your checkup.
We are the patient educationpodcast, where we bring
conversations from the doctor'soffice to your ears.
On this podcast, we try tobring medicine closer to its
patients.
I'm Ed Dolesky, a familymedicine doctor in the
Philadelphia area, and I'mNicola Rufo.
I'm a nurse and we are soexcited you were able to join us
here again today.
So we're recording from a veryspecial location, with a
(00:28):
quasi-live audience staring atus here, who is not just our
intern.
Yeah, we have our intern, who'salso accompanied by let's see,
does she have a title Our HBICyes, by the HBIC, and a crow
upstairs who is not watching.
We're driving down the.
(00:49):
We have a live audience.
We do this is the first timewe've had a live audience.
This is quite the honor andwe're just looking forward to
putting together a great episodehere today.
I hope this isn't so echoeythat this is prohibitive.
Speaker 2 (01:03):
Well, I guess we'll find out.
Speaker 1 (01:05):
We're going to find out.
So we're driving down thehighway and we see a large
bulletin board.
A bulletin board, what is it?
Billboard, Billboard thank you.
Speaker 2 (01:17):
A live audience already contributed.
Speaker 1 (01:19):
We see a live billboard that says give space
to the seals.
Why do seals need space?
Speaker 2 (01:27):
We all need space.
I feel like I relate to theseals sometimes.
Speaker 1 (01:31):
You needed space earlier today.
Speaker 2 (01:33):
Yeah, I did.
Yeah, what about it?
Speaker 1 (01:37):
Well, if anyone out there knows why seals need space
if they thrash about and offer.
Speaker 2 (01:43):
They might.
They might be aggressive validthat they're sunning on the
beach, yeah, our live audienceyeah yeah, perhaps that's it.
Speaker 1 (01:56):
Well, if anyone out there has any better idea about
why seals might need space,please let us know.
And maybe they're sunning onthe beach.
My second point I wanted toraise today is the movie Nonas.
Speaker 2 (02:07):
Oh yeah.
Speaker 1 (02:09):
What a wholesome movie on Netflix.
If you haven't seen it, gocheck it out.
Vince Vaughn is this guy whosemother passes away, and Oteca
Maria right, I think that's hername and he makes a restaurant
in her name as an homage tohonor her and her Italian
recipes, and he hires Nona's tobe the chefs.
(02:32):
It is an incredible movie.
Speaker 2 (02:34):
And he feels seen, he feels that his culture is
represented on TV.
Speaker 1 (02:40):
Finally, my upbringing as an Italian
grandmother has finally beenrecognized.
No, but truthfully, I thinkthey did an excellent job of
really putting these women tothe forefront and celebrating
them, and it was a great,wholesome, family-friendly movie
he may or may not have tearedup at the end, wouldn't you?
(03:02):
it was so beautiful he wasgetting right.
Well, I don't want to spoil itfor anyone, but I it was.
It was an amazing movie andwell, they said all the like,
the hot phrases, like they saidI mean like maroon, or that's a
sin, or like, or they talk aboutthis, like what was it?
The, the head of the, the beast, that they said the capuzel,
(03:23):
but what is?
What was the animal?
Speaker 2 (03:26):
um a sheep head a sheep head.
Speaker 1 (03:28):
Yeah, yeah, and apparently you can go to this
restaurant based on a true storyand we can talk about the true
story thing that I've hadotherwise.
Um well, I didn't know that theblind side was a true story are
you for real?
Yeah, I think when did you?
Speaker 2 (03:43):
learn this.
You didn't know.
Speaker 1 (03:46):
No, no, no.
It was only after watching themovie that it became apparent to
me, but I went the whole movieexperience thinking it was a
fictional movie.
Speaker 2 (03:54):
Oh.
Speaker 1 (03:56):
Sandra Bullock.
Speaker 2 (03:57):
Yes.
Speaker 1 (03:58):
Yeah, so that was real Unbeknownst to me.
I've known it since the moviecame out, though oh, okay yeah
that's less offensive uh, do youhave any takeaways from this
week of anything that you werehoping to talk about a little?
Speaker 2 (04:18):
bit.
Do we need to talk about yourtoilet incident last?
Speaker 1 (04:22):
night.
Why don't we?
Why don't we?
Why don't we do it?
Why don't I see how, how I feelthis was an outrageous thing.
We, you know it's not every dayyou go to the bathroom and
sometimes you, like you, havedifferent experiences.
Some are loose, some are loose,some are live audience members
(04:44):
saying you don't questioning.
Like you don't go to thebathroom every day, you know if
you have a busy morning andyou're running out sometimes you
suffer from occasionalconstipation.
Yeah, and we have an episode onthat right and you can go listen
to that if you want.
So you know I'm doing mybusiness.
We have the squatty potty.
If you haven't heard orunderstand that we do that, we
have a, a travel one.
So I'm like hanging out withthe travel squatty potty and,
(05:08):
like you know, it's a larger one, the girth is bigger than
normal and I understood that onthe way out and I give it one
flush and the water is a littleslow to go down and so I think,
ah, maybe it needs a little bitmore flow to kind of break it up
.
So I give it a second flush andthe water level rises in the
(05:30):
toilet.
And now I'm an idiot becauseI'm looking at it and I'm like a
third will do it.
Third time's the charm.
So now the bathroom door's open, nikki comes up and she's
looking around and you come intowhat.
What do you see like?
Speaker 2 (05:47):
from your perspective , it was probably one of the
funniest things I've ever seen.
He's hunched over the toiletwith like the toilet seat up and
the water's overflowing nowit's overflowing now it's
overflowing, it's all over thefloor.
My parents are downstairs andhe's like this is so bad, this
is so bad, I need it.
(06:07):
Do you have the plunger?
Do you have the thing?
I need it.
Now he's like don't tell them,don't tell them.
So I run down the stairs andI'm like eddie clogged the
toilet.
I need the plunger.
Where is it?
Speaker 1 (06:19):
and and you're like do you need me to go get?
Like, like, go get my dad.
Like, do you need me to go?
No, do not.
Do not go get him.
No, I need to fix this, do not.
And it takes it's about fiveminutes and we're right at the
cusp.
The water is at the top of thetoilet, and then we hear from
(06:41):
Mary downstairs and she's likejust click the button in the
reservoir and the water will godown.
So then you come in, thank youfor saving the day.
You click the button and thewater starts coming in again.
Yeah, and now we're gettingeven higher and higher and I'm
like oh, we're overflowing again.
Now the towels are on the floor.
I think it was a very cleanthing.
The turd was like down thepipes already, like this was a
(07:07):
downstream obstruction and Godbless, if this makes it like
live to the episode.
I mean this is gonna be crazy.
Eventually it worked out andthe plumbing works and that was
a beautiful thing that happened.
Speaker 2 (07:15):
It was yeah it was, I think.
Yeah, that's that, oh man.
Speaker 1 (07:27):
How do you feel Anything else?
You want to talk about.
I think that was.
I don't think so it's aboutseven minutes.
Oh yeah, wait.
And so then you come back andI'm like can you get like a wire
hanger or anything?
And I'm like I need, like Ineed a wire hanger, and I'm like
I need something metal.
And she's okay, let me go look.
So she comes back and she'slike we only have this.
And she comes back with aroutine plastic coat hanger.
Speaker 2 (07:51):
Okay, we're not a wire hanger family, we're a felt
hanger family and a couplerogue plastic ones.
Speaker 1 (07:59):
And I'm like why did you bring that?
And she's like this is all wehad.
And she's like this is all wehad.
It's not a comedy podcast, butI hope that you get some jokes
out of it every once in a while.
This is a good opener, goodenergy, live audience.
Speaker 2 (08:17):
I hope Mike laughs at this when he's in his basement
doing basement things.
Speaker 1 (08:21):
I can't believe that potential future patients of
mine listen to this and maybethey'll get a sense of my
character and bowel habits,hopefully, all right.
You ready?
Yeah, all right.
What are we going to talk abouttoday, nick?
Speaker 2 (08:35):
Today we're talking about pre-diabetes.
Speaker 1 (08:38):
Yeah, this is such an important episode and I really
want to call light that thisepisode fills the gap in this
type of situation.
You went to the doctor, you hada nice visit with them, they
decided to get some labs and hesaid I'm just going to get some
labs to do some metabolicstudies and then you get the
results back and they give youtheir interpretation.
(09:00):
And they give you a little oneline or you see a little thing
like hemoglobin a1c 5.8, andthey send you a message and they
say sorry, we detected that youhave pre-diabetes.
Good luck, do some diet andexercise and see you later.
This episode, I hope, fillsthis gap because that is such a
(09:23):
common thing that happens.
This whole thing is so common,in fact, that it's estimated.
Because there's a thing here isthat it's estimated that more
than 96 million Americans thatis, over one third, one in three
people, have prediabetes and asmany as 80% of people don't
(09:45):
know they have it.
Let's sit with that for a secondDone done, done, done, done,
done, but really like people arefloating around out here with
pre-diabetes not knowing it.
Now this wasn't a thing likeforever, like when I was in med
school.
Some doctors were likepre-diabetes wasn't a thing back
in my day, but it is now.
(10:06):
So that's why we're going totalk about it here today.
So pre-diabetes doesn't onlyincrease the risk for getting
diabetes itself.
It independently has risks forheart disease, stroke and kidney
disease.
And so today we're going toinform you and empower you with
facts, tools and hopefully, bythe end of it, some hope.
(10:27):
Nikki, can you take us throughand tell us what is prediabetes?
Speaker 2 (10:36):
Prediabetes is?
The explanation is prettysimple it's when our blood sugar
is elevated, so it's high, butit's not high enough to call it
diabetes.
Speaker 1 (10:46):
To capture the diagnosis of prediabetes.
The American DiabetesAssociation in 2025 says that
you need a fasting plasmaglucose.
What does that mean?
You haven't eaten in eighthours and you got your blood
work done and you have a bloodsugar between 100 and 125
milligrams per deciliter.
And I have to correct myself,because we have an international
(11:08):
audience, that that is not themillimole number, so that's just
the American standard numbersreported.
You can have a two hour oralglucose tolerance test, which is
less common because it's kindof cumbersome.
You have to drink a glucosesolution and then get your blood
sugar measured two hours later.
But if you do that and yourblood sugar is measured between
(11:29):
140 and 199 milligrams perdeciliter, they call that
impaired glucose tolerance, asopposed to impaired fasting
glucose, which is a differentstory.
And most commonly, I would say,comes up the hemoglobin A1C,
which will restate is that threemonth average of your blood
(11:50):
sugar that you know when bloodsugar plucks on your red blood
cells.
The lifespan of a red bloodcell is about 90 days or three
months, so it's like the threemonth report card of your blood
sugar and if that level isbetween 5.7 and 6.4%, that is
pre-diabetes and it's importantto know that many people feel
(12:11):
totally fine, they don't feelsick, and that's why this is
kind of like a yellow flag, asilent warning that happens.
So, nikki, we talked about likethe diagnosis and how you
capture that, but who is at riskfor pre-diabetes?
Speaker 2 (12:24):
about, like the diagnosis and how you capture
that.
But who is at risk forprediabetes?
So people who are 45 years orover, um, anyone who's
overweight or obese, so with aBMI of over 25 or 23.
For Asian Americans, familyhistory of diabetes, low
physical activity, any historyof gestational diabetes or PCOS,
(12:45):
high blood pressure, and thencertain racial groups.
So black, Hispanic, NativeAmericans, Asian American and
Pacific Islanders are more atrisk.
Speaker 1 (12:58):
Yep, and there are certain tools available, like
the American DiabetesAssociation has a risk test.
So this is a simple onlineself-screening tool and
truthfully like, if you could.
I think there are differentguidelines from different groups
that make these guidelines,like the USPSTF or American
Diabetes Association havedifferent opinions about who
(13:21):
should get screened, soessentially, you should ask your
doctor about what the rightplan is for you.
Speaker 2 (13:28):
So before we get into what we can do about
prediabetes, let's talk aboutwhy it's important.
Speaker 1 (13:36):
This is going to be a bigger conversation, so kind of
buckle in for this one.
The risk of diabetes issomething I want to spend more
time on, so I'm going to startwith the other ones.
Prediabetes itself has beendescribed in the literature that
there is an increased risk,independently of anything else,
of heart attack, stroke andchronic kidney disease just by
(13:59):
having prediabetes.
So that in and of itself makesit important enough to pay
attention to.
And oftentimes people when theyhave prediabetes also may have
hypertension or they may havedyslipidemia or otherwise
abnormal cholesterol levels andthey may have central obesity,
(14:20):
which that visceral fat, thatfat that lives around the belly
is worse than compared to othertypes of obesity and subtypes.
So then the big question comesof I have prediabetes not me,
but someone, like a supposition,saying like I have prediabetes,
what does that mean for me?
(14:41):
So there's a lot of literaturethat says that the annual
progression that there's aboutlike a five to 10% risk every
year of developing diabetes whenyou have prediabetes.
There are European studies thattry to estimate lifetime risks,
but you can imagine that that'sa little tricky because someone
(15:02):
may be 20 with prediabetes andthen you might have someone who
is 70 who discovers that theyhave prediabetes, and those two
people are in different riskgroups.
So there's a European studythat states that the lifetime
risk of developing type 2diabetes for someone with
(15:22):
prediabetes is 74% and that'spretty high.
But I think that that doesn'treally totally like calculate
that, like someone who's 20years old has like an 88% chance
of developing diabetes if theyhave prediabetes.
So to sort of round that up andsummarize it, if you have
(15:42):
prediabetes every year there'sabout a 10% chance of developing
diabetes and in a lifetimethere are lots of different
studies and it matters how oldyou are, but it could be 74%,
could be as high as 88% in thelifetime if you don't take
action to prevent that now.
Does that invoke any feelingsor thoughts?
(16:03):
Did you know that like off thedome or?
I mean not those specificnumbers, but I feel like that's
important to know, because Ifeel like people are told they
have pre-diabetes and thenthey're just like, oh well, I
don't have diabetes right and itmatters, like they we're going
to talk about like medicines inthe like later parts of the
(16:25):
episode, but like there are highrisk pre-diabetes groups, like
if you're over six or you'reyounger that's a much higher
risk, or your BMI is over 35.
Like much higher risk ofdeveloping diabetes than someone
without those things.
I'm going to save a little bitof that conversation for after,
but that's sort of why this isimportant Because it affects
(16:48):
your heart health.
Stroke risk, chronic kidneydisease risk and overall the
risk of developing diabetes issignificant.
So why don't we take a littlebit of time after being a little
doom and gloom of like oh mygosh, I have prediabetes?
You probably now have thoughtmore about prediabetes if you're
making it this long through theepisode than you ever have
(17:09):
before.
Prediabetes if you're making itthis long through the episode
than you ever have before.
But what can we do to preventprogression to diabetes and kind
of manage those other riskfactors?
Speaker 2 (17:21):
There are a lot of things that we can do, and we
actually have multiple episodeson all of these things, and
that's because, well, medicationaside, all of them are
lifestyle changes, which are thecornerstone of prevention.
Speaker 1 (17:38):
Totally so.
These um, this data isn't justpulled out of thin air.
There were massive studies thatwere done and continue to be
done.
But a lot of this data that I'mgoing to say next comes from a
very large study called theDiabetes Prevention Program and
that showed and I'm going togive you very specific numbers
here, because I think when wetalk about goals we like to have
(18:01):
something like a smart goal andthis falls under the S of that
specific Losing just 7% of yourbody weight and entertaining or
doing 150 minutes of moderateintensity exercise a week
reduced the risk of diabetes by58% Just those things.
(18:23):
So a 7% weight loss is that canbe challenging to get, but it's
not insurmountable and we cantalk about how they did that,
but that's what they found.
That study was done over thecourse of three years, so
(18:46):
there's like a little bit of alimit to that.
And another piece is that youeven get some benefit even if
you don't lose weight and youjust exercise.
They also looked at people whodidn't lose weight and they just
did physical activity goals andthat cut the risk of diabetes
by 44%.
So even if you're just movingand you don't lose any weight,
it's still worthwhile to doexercise, and we've talked about
(19:06):
why exercise is so important,beyond weight loss or anything
else like improving your sleep,improving your mood, your
cognition.
Now here's another reason.
So what else they did?
How do you like?
We've talked a little bit aboutthis in other episodes, but to
kind of like talk about how theylost weight in this study was
(19:27):
they looked at the amount ofcalories that it took someone to
stay the same weight and theyfound that out, just like in
their diet, tracking what theyate.
And then they subtracted 500 toa thousand calories a day.
And then they act.
They went for 700 calories aday of physical movement, and so
(19:48):
in creating that, they wereable to induce this calorie
deficit and help people losetheir weight.
And because so we have aquestion from our audience here
of what does 700 calories looklike?
And because that's achallenging thing to capture,
they translated that into 150minutes of moderate intensity
(20:10):
exercise a week.
Oh yeah, and so otherwise thattranslates into 30 minutes five
times a week.
And to the weight loss end,since we were talking about that
a little bit, there also wasevidence from the diabetes
prevention program, that said,for every kilogram of weight
lost.
So for our overseas folks,congratulations.
(20:30):
We're using the metric system.
For those in the United Statesit's about two pounds.
For every two pounds lost,there is a 16% reduction in
transition to diabetes over thecourse of the three years.
Just to give you a little bitmore, and they saw more was
better in terms of like 10%.
If you lost 10% of your bodyweight, great, even more benefit
(20:52):
, less risk of developingdiabetes.
So we talked about weight loss,we talked about physical
activity and their role inreducing the risk of going to
diabetes.
What about nutrition?
What certain things should wethink about here, or what
(21:12):
opportunities are there forpeople to have their improvement
?
So in the study for thediabetes prevention program,
they found that no single idealmacronutrient distribution
worked.
What the heck does that mean?
No amount of carbs compared toprotein compared to fat actually
made a heck of a difference forpreventing diabetes, and it has
to be personal for thatindividual.
(21:34):
But there are some effectiveeating patterns that are very
well known to help preventdiabetes, and these include the
Mediterranean diet.
Certain low-carb diets andplant-based or the DASH diet are
well known to help preventtransition from prediabetes to
diabetes, and the key piece ofthis knowing is that you really
(21:57):
just have to find what works foryou, and so there are certain
foods that we can emphasize.
Nikki, can you take us throughwhat foods, like we did on our
prior episode, what foods toemphasize and then what things
we might be able to minimize aswe think about food and the
nature of preventing diabetes?
well, we want to emphasize wholegrains, nuts, fruits,
(22:20):
vegetables and our favoritelegumes and I'm not legume or
legume Anyway, and what sorts ofthings should we try to limit?
Speaker 2 (22:34):
We're trying to limit refined and processed foods.
Speaker 1 (22:38):
Yeah, also high in sodium oftentimes, and so for
those people out there trying towatch their hypertension, that
might not be helpful.
There are certain like scores Iwas looking up like there's the
healthy eating index, thealternative healthy eating index
and the dash score are allresources that you can look up
online and kind of measure howgood a food is if you're curious
(22:59):
.
And, honestly, this is a greattime for a dietitian to step in
and help educate people Because,as you know, here, like, we're
listing a bunch of foods but wedon't talk about portion sizes,
we don't talk about, like eatingthroughout the day and how to
manage that, and, honestly,they're so talented and it's a
whole specialty in and of itselfthat gets its whole education.
(23:20):
So we're not going to pretendlike this is the be all end, all
education, but it's somethingthat you should think about
because it's very important.
Something else when it comes tonow we've talked about three
things.
We've talked about weight loss,physical activity and nutrition
, and the guidelines from theADA specifically call out sleep
(23:41):
in this year's recommendationsfor preventing prediabetes and
they now recognize that poorsleep is a key contributor of
preventing diabetes, that poorsleep is a key contributor of
preventing diabetes.
They highlight sleep less thansix hours or greater than nine
hours linked to a 50% increasedrisk of diabetes.
Speaker 2 (24:00):
We have to get rid of those blackout curtains here.
I know you sleep like ateenager down here.
Speaker 1 (24:07):
Totally yeah.
I'm like a cozy boy in themorning.
I just don't want to get up atall.
Speaker 2 (24:14):
And then increasing your risk of diabetes by
sleeping more than nine hours.
I know I didn't sleep more thannine hours last night.
Speaker 1 (24:21):
And then they said that poor sleep quality is
linked to about 40 to 84%increased risk.
That's a big broad range, sowe'll keep it light there, but
really you should think aboutsleep hygiene.
We have an episode on that, andstress reduction can be a
really important part ofpreventing diabetes.
So all those four things thatwe talked about are all things
(24:42):
that you can start doing at homewithout a doctor.
You just get outside, startstart exercising, maybe get a
gym membership, or find someonein your family, go for a walk
after dinner.
Whatever it is.
You can get started today.
You don't have to wait.
Speaker 2 (25:02):
Exercise, eat well and don't watch reality TV
before bed, so you can sleep.
Speaker 1 (25:09):
That's a crazy thing.
Speaker 2 (25:11):
It's actually so annoying, yeah like I know we
talk about like sleep hygieneand all the things that you can
do, blah, blah, blah.
We have a whole episode we bothlike.
Two nights this week we watchedtv in bed before we went to
sleep.
Both couldn't sleep.
And then the following twonights we didn't look at our
phones and didn't watch TVbefore bed and we slept the
(25:32):
entire night.
Yep Didn't wake up until ouralarms went off.
So annoying.
Speaker 1 (25:37):
It was so annoying.
And now we just watch our TVdownstairs and then when we go
upstairs we just don't, becauseyou got the whole projector
thing and it's nice, it's likebig.
Speaker 2 (25:45):
Yeah, it's entertaining.
And our king bed In our kingbed, I know it's a premium TV
experience.
Yeah, it's a sin.
Speaker 1 (25:57):
So we spent a lot of time talking about lifestyle
changes for prevention ofdiabetes and we want to take
(26:20):
some time to talk about when wethink medication might help,
because the American DiabetesAssociation does highlight
certain times where it can behelpful.
So metformin ends up being themost studied and safest
medication used to helppre-diabetes or to prevent
progression to diabetes whensomeone has pre-diabetes.
It also happens to be one ofthe most common first line
treatments of diabetes as well.
And, nikki, can you take usthrough a little bit of what
(26:40):
makes someone higher risk, whenthey have prediabetes, of
progressing to diabetes?
We teased at them before, butcan we say them out loud so
everyone knows?
We teased at them before, butcan?
Speaker 2 (26:51):
we say them out loud so everyone knows.
Speaker 1 (26:52):
So people who are 25 to 59 years old, have a BMI
equal or greater than 35, havean A1C of 6% or higher or a
history of gestational diabetesno-transcript equal, and so it's
(27:37):
a personal choice.
But that's just some of thedata that we have and truthfully
, we listed those parameters.
But metformin is more effectivein younger adults and those who
have obesity.
A little note on metformin foranyone listening long-term
metformin use can lead to B12deficiency and deserves periodic
screening of that lab.
(27:58):
Usually that increases withtime and the higher risk is seen
four to five years aftertreatment.
We I mean we have a lot ofepisodes and we'll have more
episodes in the future aboutother medications to help
prevent diabetes.
All of the medications thathelp people lose weight by way
of accomplishing that weightloss of at least 7%, help reduce
(28:20):
the risk of progression todiabetes.
But these include medicineslike semaglutide, liraglutide
orlistat, which really isn'tused much anymore, liraglutide
orlistat, which really isn'tused much anymore, phentermine,
topiramate and the big gun,terzepatide, otherwise called
Zepbound or Moonjaro, and theyshow benefit very clearly.
(28:41):
We don't have data for youright off the top, but I was
listening to other podcastsrecently that was quoting from
experts like 95% reduction withthe GLP-1 agonists in
progression to diabetes, butunfortunately these aren't fda
approved for specifically theprevention of diabetes and,
honestly, are really not coveredby insurance often for these
(29:02):
specific indications at all, andso metformin remains the
easiest, most accessible, mostaffordable medication that could
be used and leaves room forconversation with your doctor as
we kind of get to the tail endof the episode here.
I really wanted to highlight theopportunity to reduce
cardiovascular risk when peoplehave prediabetes.
(29:25):
Now that's an additional riskfactor and oftentimes, like we
said before, people usually haveproblems with their blood
pressure at this point.
They have problems withcholesterol oftentimes, and if
someone's smoking, it is like apeak time to really stop smoking
, because that is the worst ofall for cardiovascular risk
reduction.
And if you were to really combthrough the American Diabetes
(29:46):
Association guidelines and Ithink I might be opening a can
of worms here, becauseapparently statins are a hot
button topic what they found inthe diabetes prevention program
was that the statin wasassociated with a greater
diabetes risk.
So it's real, it'sstatistically significant that
(30:06):
they do slightly increase therisk of diabetes and tipping
people over the edge when theyhave prediabetes.
And so then they took thatinformation and they compared
that fact of knowing that thishappens and compared it against
the benefit that statins have atreducing cardiovascular
(30:26):
mortality and death, and thebenefit of reduction in
mortality is still greater thanthe slight increased risk of
diabetes onset.
And so, then, theirrecommendation is that you
should still use the statin andyou shouldn't stop the statin if
this happens, which is a trickything because for some reason,
(30:52):
they're such a hot button topic.
Speaker 2 (30:53):
People love to come for the statin.
They do.
Speaker 1 (30:56):
They're like one of the best medicines out there.
So weird, the best medicines wehave and people love to come
after them.
For some reason, and likeanytime we're being active
online like this is the medicinethat by far gets the most hate
of any of them and it's justcrazy.
So, overall, the AmericanDiabetes Association says
(31:17):
discontinuation of statins dueto concerns of diabetes risk is
not recommended for people withprediabetes, which is a very
nuanced thing that like I don'tknow anyone who would take the
time in an office visit toexplain.
So then you get the peopleonline with the, the highlights
saying like statins causediabetes.
Speaker 2 (31:37):
Yeah, but like causing something and slightly
increasing a risk for somethingare very different when, like,
they knowingly already decreasethe risk of death.
Speaker 1 (31:46):
Yeah, making people live longer.
So so, when it comes topreventing pre-diabetes, we
talked a lot today and we talkeda lot today about, like, why is
important what you can do toprevent it?
Uh, I mean, the cdc is in fluxin terms of how much we can
trust their information withcurrent administration changes
(32:07):
and the department of health andHuman Services.
But there are programs.
There are diabetes preventionprograms that you can go out and
ask your doctor for.
In the community.
You can get some advice.
Dieticians are out there and goexercise.
Go out there, do whatever yougot to do to be able to help
prevent diabetes.
(32:30):
So we have some closing thoughts.
They are that pre-diabetes isreversible, but you really do
have to take action and yourhealth is worth the investment
and even the small steps thatyou take really do matter.
So three things to think aboutare to ask your doctor if they
think you should have your A1Cchecked.
A brisk walk counts.
So move your body and try toeat more whole foods and watch
(32:53):
your portion sizes and don'tsnack.
So thank you for coming back toanother episode of your Checkup
.
Hopefully today you were ableto learn something for yourself,
a loved one or a neighbor withprediabetes.
Feel free to check out ourwebsite, send us an email if you
felt like you wanted to talk tous about this episode, and my
one call to action for you is tofollow the podcast so that you
(33:15):
can see when our next episodecomes out and, if you're really
willing to take a step further,share it with a loved one or a
neighbor so that, because onethird of them have prediabetes
and they don't probably don'tknow it, so maybe they'll get
something out of this episode.
Most importantly, stay healthy,my friends, until next time.
I'm Ed Dolesky.
Speaker 2 (33:33):
I'm Nicole Rufo.
Speaker 1 (33:34):
Thank you and goodbye .
Speaker 2 (33:36):
Bye.
Speaker 1 (33:39):
This information may provide a brief overview of
diagnosis, treatment andmedications.
It's not exhaustive and is atool to help you understand
potential options about yourhealth.
It doesn't cover all detailsabout conditions, treatments or
medications for a specificperson.
This is not medical advice oran attempt to substitute medical
advice.
You should contact a healthcareprovider for personalized
guidance based on your uniquecircumstances.
(34:01):
We explicitly disclaim anyliability relating to the
information given or its use.
This content doesn't endorseany treatments or medications
for a specific patient.
Always talk to your healthcareprovider for complete
information tailored to you.
In short, I'm not your doctor,I am not your nurse, and make
sure you go get your own checkupwith your own personal doctor.
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