USNEWS：糖尿病前期：既然患有糖尿病你就应该知道怎么办！

加州大学旧金山分校医学中心（UCSF Medical Center, San Francisco, CA）

2018年12月13日

雪松-西奈医学中心（Cedars-Sinai Medical Center, Los Angeles, Calif.）

2018年12月19日

发布者 ihealth66 在 2018年12月19日

分类

健康新闻

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By Samantha Costa and Michael O. Schroeder

美国的糖尿病患病率非常高！有多高？三个美国人中就有一个！所以该病也得到了各界的关注！本篇文章就由两位USNEWS著名的健康专栏作家共同执笔，可见获得的重视！糖尿病的病因很多，这里就不详述；发展的过程也很复杂，但各个患者基本上都有一个前期症状。因此，一旦出现糖尿病的前期症状，就需要注意如何对待自己！由于糖尿病的并发症很多，也很严重，如何控制住糖尿病的进展，降低糖尿病并发症的出现，就成了各医学专家的重点研究对象。本篇文章就是从科普角度，对这方面的问题进行了详细的阐述。运动与饮食仍是控制糖尿病进展的最强有力的两件法宝。在文章最后，详细列举了最新的糖尿病患者推荐食物表，希望在与糖尿病的抗争中，对患者有所助力！

ACCORDING TO DATA released in November, diabetes rates have increased in 18 states in the U.S. over the past decade – from West Virginia to Hawaii – and gone down in none.

That data, collected as part of the Gallup-Sharecare Well-Being Index, tallies Americans’ answers to the question, “Has a doctor or nurse ever told you that you have diabetes?” But in addition, many people with diabetes remain undiagnosed – and many more are at risk for developing the chronic disease, since they also have higher than normal blood sugar levels, or what’s called prediabetes – a precursor to diabetes.

According to the Centers for Disease Control and Prevention, about 1 in 3 adults in the U.S., or more than 84 million, have prediabetes – “a condition that if not treated often leads to Type 2 diabetes within five years.” That’s in addition to about 1 in 10, or more than 30 million who have diabetes.

What Is Prediabetes?

“Prediabetes is basically based on certain blood values that puts a person at risk for full-blown diabetes,” explains Dr. Gregg Faiman, an endocrinologist at University Hospitals in the greater Cleveland area. For example, one considers a person’s fasting blood sugar. Normal fasting blood sugar is below 100. Diabetes range fasting blood sugar is 126 or higher, while for a person with prediabetes, he notes, it’s in the range of 100 to 125.

Another test, hemoglobin A1C, provides a picture of a person’s average blood sugar over the past two or three months. A normal A1C level is less than 5.7. For someone with diabetes, it’s 6.5 or above; while those with prediabetes have an A1C of 5.7 to 6.4.

Are There Prediabetes Symptoms and Risk Factors?

Even some people with diabetes may have symptoms that are so mild they go unnoticed; but typical symptoms one may experience range from urinating often and feeling very thirsty and hungry – even though you’re eating – to extreme fatigue, according to the American Diabetes Association.

However, commonly there simply are no outward signs of prediabetes, or symptoms to point to a problem. One exception is that some people with prediabetes (as well as individuals with diabetes) will develop what’s called acanthosis nigricans, says Marilyn Anderson, a registered dietitian and certified diabetes educator at DMC Harper University Hospital in Detroit. This is characterized by darker areas often in skin folds, like on a person’s neck or armpits.

People who are overweight, inactive or have a family history of diabetes have the greatest risk of developing prediabetes. “If somebody is diagnosed (with prediabetes), it doesn’t mean they will get diabetes, but it does mean they’re at a higher risk than someone without diabetes,” says Dr. Margaret Powers, a research scientist at Park Nicollet International Diabetes Center in Minneapolis.

The CDC recommends talking with your doctor about getting your blood sugar tested if you have any risk factors for prediabetes, including if you:

Are overweight
Are 45 years or older
Have a parent, brother or sister with Type 2 diabetes
Are physically active less than 3 times a week
Ever had gestational diabetes, a type of diabetes some women develop during pregnancy, or have given birth to a baby who weighed more than 9 pounds
Have polycystic ovary syndrome

Race is also a risk factor. “Although it’s unclear why, people of certain races – including African-Americans, Hispanics, Native Americans, Asian-Americans and Pacific Islanders – are more likely to develop prediabetes,” according to the Mayo Clinic.

Prediabetes Treatment, and Preventing Type 2 Diabetes

Experts emphasized those who are diagnosed with prediabetes should view it as an opportunity to prevent developing full-blown diabetes.

“The first thing we’ll focus on is lifestyle changes,” Faiman says. “So watching diet. If patients aren’t exercising, getting them to start exercising.”

Hillary Wright, a registered dietitian at the Dana-Farber Cancer Institute in Boston and author of “The Prediabetes Diet Plan: How to Reverse Prediabetes and Prevent Diabetes Through Healthy Eating and Exercise,” says the most effective way to normalize blood sugar is to lose weight and exercise, a highly effective strategy validated by the often-referenced Diabetes Prevention Program study.

The landmark study, published in the New England Journal of Medicine in 2002, included 3,234 adults age 25 and older with prediabetes across 27 U.S. clinical centers, who were divided into three treatment groups. Patients assigned to the lifestyle intervention group were given an intense education on diet, physical activity and behavior-modification strategies. The second group was put on a commonly used diabetes drug – metformin – and given information about diet and exercise without counseling. The third group was given a placebo pill without active ingredients. Ultimately, the first group yielded the best results, achieving a 58 percent decreased rate of diabetes compared with the placebo group. The metformin group showed a 31 percent reduced risk for Type 2 diabetes compared with the placebo group.

The biggest challenge for those with prediabetes is to feel motivated enough to make the necessary changes, Powers says.

Anderson says she works with patients who have prediabetes to develop an individualized eating plan that moderates – but isn’t about drastically cutting – carbohydrate intake. “We don’t do a low-carb diet,” she says, though she does have prediabetes patients count carbs and spread carb consumption evenly across meals throughout the day.

People often erroneously believe that cutting carbohydrates is the key to losing weight and eating healthier, Wright says, but it’s more about designing a balanced plate. Reserve half of your plate for non-starchy vegetables such as broccoli, spinach, salad, cauliflower or carrots. One-quarter of the plate should consist of lean poultry, meat or plant protein such as legumes or tofu. The final quarter should include a nutrient-dense whole grain, such as brown rice, pasta or quinoa or colorful, starchy vegetables such as winter squash, corn, peas or a sweet potato.

People with prediabetes have insulin resistance, meaning they have to produce a lot of insulin to control their blood sugar. In turn, Faiman explains, “Insulin stimulates appetite. Insulin can cause people to be fatigued, and insulin causes people to gain weight, which propagates the problem, because weight gain itself makes people less sensitive to insulin.”

When medication is needed to help break the cycle, metformin is still the one that’s typically used. “It makes patients more sensitive to the insulin their body’s producing,” Faiman explains. This allows a person to achieve normal blood sugar levels, or euglycemia, with less insulin. “So if insulin makes patients gain weight, less insulin should help them lose weight, and weight loss itself then makes them more sensitive to insulin, which should help decrease their risk for developing full-blown diabetes,” he says.

Margaret Eckert-Norton, chair of the Endocrine Society’s Advocacy and Public Outreach Core Committee, says making changes to your eating habits could be as simple as assessing how often you eat out. If you go to your favorite takeout restaurant and find yourself waiting 20 minutes for your order, think about what you could have cooked at home during that time.

Eckert-Norton, a diabetes educator, says some people have no idea how to do anything more than microwave. “That’s probably still better than takeout. Frozen vegetables are a perfectly good option,” she says. “It sounds like a drag, but it’s economical and healthful.”

If your primary care provider encourages you to see a specialist, there are ways to prepare for the first appointment, Powers says. First, keep an honest food and physical activity diary for three to five days per week before your visit.

“They can look it over and have a conversation about where the patient feels they could make changes, and often people know what they need to do,” Powers explains. “It’s finding the right support that’s going to help them make the changes they can maintain for their life at that time.”

Powers recommends that patients with prediabetes, as well as those with diabetes, locate a registered dietitian who can help create a meal and exercise plan. She also advises they seek emotional support from a psychologist if the lifestyle changes become too overwhelming. The CDC has also collaborated with YMCA to develop diabetes prevention programsthat can be individualized to meet a participant’s needs, Powers says.

If you can’t afford a gym membership, Eckert-Norton recommends finding an exercise buddy to run up and down a flight of stairs with (if you’re heart-healthy enough to sustain it). If you’re living in a 55-and-over development or senior citizen housing, check to see if your community offers exercise classes. The bottom line: just move more.

Also, experts reiterate, being diagnosed with prediabetes doesn’t mean it’s inevitable that you’ll develop diabetes. “I would look at the diagnosis as a wakeup call,” Faiman says. “What I tell patients is, you look at the pre- as prevent – because they have the option of preventing diabetes.”

Best Diabetes Diets

RANK	DIET NAME

#1	Mediterranean Diet
#2	DASH Diet
#3(tie)	The Flexitarian Diet
#3(tie)	Mayo Clinic Diet
#3(tie)	Vegan Diet
#3(tie)	Volumetrics Diet
#3(tie)	WW (Weight Watchers) Diet
#8(tie)	Jenny Craig Diet
#8(tie)	MIND Diet
#10(tie)	The Engine 2 Diet
#10(tie)	Ornish Diet