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People with diabetes are often surprised by their diagnosis. But the truth is, diabetes tends to develop gradually.

It starts with a condition known as pre-diabetes. According to a new estimate from the Department of Health and Human Services (HHS), 41 million Americans are living with pre-diabetes, which is about 20 million more people than previous thought.

HHS based their estimate on a new definition of pre-diabetes developed by the American Diabetes Association last year. Experts say it's important for Americans to know that 40 percent of US adults from ages 40 to 74 have pre-diabetes because of the risks associated with this condition.

"In the past, pre-diabetes was thought as 'a touch of diabetes,' but not anymore," says Astrid Almodovar, MD, an assistant clinical professor of family medicine at University of Medicine and Dentistry of New Jersey with a private family practice in Newark. "Today, even if you don't progress to diabetes, pre-diabetes indicates a risk of cardiovascular disease and stroke."

According to the American Diabetes Association, pre-diabetes is defined as a condition in which blood glucose (blood sugar) levels are higher than normal but not at a diabetic level. Doctors use two tests to identify people with pre-diabetes: impaired glucose tolerance (IGT) tests and impaired fasting glucose (IFG) tests. An IGT test checks your blood sugar two hours after a meal. If your blood sugar level is between 140 mg/dL and 199 mg/dL that indicates you have pre-diabetes. Because some external factors, such as exercise, may affect an IGT test, more specific information can be gathered from an IFG test, which is given in the morning before breakfast. Someone with pre-diabetes will have blood sugar levels between 100 and 125 mg/dL in the IFG test.

Some lab reports may focus on reporting a "positive" or "negative" after either test, but it's important to find out your number and not just the range. "Being close to 100 is still a warning sign," Dr. Almodovar says. Knowing your blood sugar level will help you set your goal: to lower your count to a safe number. It's important to get your blood sugar below the pre-diabetic levels because pre-diabetes can lead to heart disease and stroke.

Certain groups of people are at increased risk for both pre-diabetes and diabetes. For example, anyone over 60 years old and anyone with family history of diabetes is at risk. Diabetes appears very prominently in people with certain ethnic backgrounds: African American, Hispanic, Latino, American Indian, Alaskan native, Asian and Pacific Islander. Your body may also alert you to test for pre-diabetes with other clues that, collectively, suggest you're at increased risk. These include blood pressure over 140/90 mm Hg; HDL (good cholesterol) levels below 40 mg/dL for men or below 50 mg/dL for women; or triglyceride levels above 250 mg/dL.

Many people with pre-diabetes develop type 2 diabetes within a decade. But making lifestyle changes can help keep pre-diabetes from escalating to diabetes. The Diabetes Prevention Program (DDP), which is sponsored by the National Institutes of Health, recommends taking steps to lower body weight by 5 to 7 percent because being overweight can put you at risk. This can be achieved by calorie cutting, fat intake reduction and exercise.

People with pre-diabetes should also consider a walking program. Just adding 30 to 40 minutes of walking, five days a week, can increase your chances of avoiding diabetes by up to 58 percent. "Everyone has 48 half-hours in their day," Dr. Almodovar says. "If you dedicate just one of these 48 half-hours to promoting health, you're keeping diabetes at bay."

Drew Voight

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