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Pre-diabetes Threshold Lowered
This article notification service provided by http://www.medscape.com
Revised Diabetes Guidelines Lower Threshold for Impaired Fasting Glucose CME News Author: Laurie Barclay, MD CME Author: D?sir?e Lie, MD, MSEd Authors and Disclosures Release Date: October 24, 2003; Valid for credit through October 24, 2004 Oct. 24, 2003 ? An international expert committee on the diagnosis and classification of diabetes mellitus has published revised guidelines, which incorporate new data since the last report of 1997, in the November issue of Diabetes Care. Decreasing the cutoff for impaired fasting glucose from 110 mg/dL to 100 mg/dL could increase diagnoses of prediabetes by approximately 20%. "Lowering the threshold should help pick up more people who are at increased risk for developing diabetes," Committee Chair Saul Genuth, MD, from Case Western Reserve University in Cleveland, Ohio, says in a news release. "What's important about that is that we now know ? through studies such as the Diabetes Prevention Program (DPP) and the Finnish Diabetes Study ? that we can prevent or delay the progression to diabetes from impaired glucose tolerance, the original component with the term pre-diabetes, through intensive lifestyle treatment, such as exercise and diet therapy. We hope, but don't yet know, that intervening earlier might also reduce the risk of diabetic complications, including cardiovascular complications." Modest weight loss and regular exercise can prevent or delay the development of type 2 diabetes by up to 58%, based on results of the DPP and other studies. Criteria for the diagnosis of diabetes remain unchanged, and the committee recommended against using the HbA1C as a routine diagnostic test for diabetes. Although clinical evidence is currently inadequate for superiority of either the fasting plasma glucose (FPG) test or the oral glucose tolerance test (OGTT), the committee prefers the FPG because of its greater convenience and lower cost. The American Diabetes Association (ADA) recommends that individuals aged 45 years or older, especially those who are overweight or obese, be screened for diabetes/prediabetes and retested every three years if normal. Individuals at increased risk because of obesity, family history, gestational diabetes, or other recognized risk factors for diabetes should be considered for screening every few years, according to Dr. Genuth. Unanswered questions mandating further research include defining the best approach to diabetes detection, understanding the pathophysiology and risks of IPG and glucose tolerance, and determining to what extent cardiovascular risk can be lowered by starting treatment of glycemia earlier. "The answers to these and other questions will necessitate regular surveillance and reconsideration of new data that may lead to appropriate revisions to the diagnostic and classification criteria for diabetes over time," the authors write. Diabetes Care. 2003;26:3160-3167 Learning Objectives Upon completion of this activity, participants will be able to: List the changes in recommendations for the diagnosis of diabetes since the 1997 Expert Committee report of the ADA. Describe the updated criteria for prediabetes and diabetes screening. Clinical Context The 1997 International Expert Committee was convened to examine the classification and diagnostic criteria of diabetes, based on the 1979 report of the National Diabetes Data group and the World Health Organization (WHO) study group. The WHO criteria for diagnosing diabetes is FPG of 126 mg/dL or higher or two-hour plasma glucose (PG) of 200 mg/dL or higher in the OGTT after a 75 g oral glucose challenge. The criteria were adopted by the ADA in 1997. The two-hour PG has been considered the de facto "gold standard" because it is a better predictor of all-cause mortality or cardiovascular mortality than an elevated FPG value. The FPG cutoff value is based on the prediction of retinopathy beginning at approximately 126 mg/dL. Impaired glucose tolerance is defined as FPG of 110 mg/dL or higher when two-hour PG after a 75 g oral glucose challenge is 140 to 199 mg/dL. The lack of a suitable marker of diabetes has led to a reliance on metabolic abnormalities such as hyperglycemia t! o determine risk and diagnosis of diabetes. Currently, diabetes and prediabetes screening is recommended by the ADA for patients with risk factors for the disease including obesity, age 45 years or older, family history, or gestational diabetes. If the test is normal, retesting is recommended every three years. If prediabetes or impaired glucose tolerance is diagnosed, there is a higher risk of developing diabetes within 10 years and lifestyle modification is recommended. The expert committee was reconvened for this position statement to reconsider the questions of (1) cut point of the FPG and two-hour PG for diabetes diagnosis, (2) reduction of the lower limit for impaired fasting glucose from 110 mg/dL to 100 mg/dL, (3) inclusion of the HbA1C as a diagnostic criterion for diabetes, and (4) use of the two-hour PG in addition to the FPG for diagnosis of diabetes. The recommendations are based on new studies that have emerged since 1997. Study Highlights The cut point for FPG and 2-hour PG will remain unchanged from 1997. There is no consistent difference in the prevalence of diabetes across populations observed by using the 1997 criteria. Recent studies have not shown an advantage for reducing the 2-hour PG cut point to 180 mg/dL. It was noted that the 2 tests measure slightly different constructs and result in different prevalence of diabetes. In patients with a new diagnosis of diabetes, a confirmatory test is recommended after the initial test. The cut point for impaired fasting glucose was reduced from a definition of 110 mg/dL to 100 mg/dL. Impaired fasting glucose is now redefined as an FPG of 100-125 mg/dL. This is based on observations that the receiver operator characteristic curve closest to the ideal of 100% sensitivity and specificity for the glycemic range of 81-126 mg/dL was 103 mg/dL in a Dutch population, 97 mg/dL in a Pima Indian population, 94 mg/dL in a Mauritius population, and 94 mg/dL in a San Antonio population, all values below the older 110 mg/dL cut point. This proposed new definition for impaired fasting glucose will increase the number of individuals with prediabetes and thus increasing the number of people who may benefit from intensive lifestyle modification such as weight reduction and exercise to prevent diabetes onset. HbA1C is not recommended as an additional criterion for the diagnosis of diabetes. The reasons are lack of international standardization of reference ranges and the confounding effect of other conditions (such as pregnancy, uremia, hemoglobinopathies, blood transfusion, and hemolytic anemia). HbA1C is still recommended as an indicator of therapeutic response. Both FPG and 2-hour PG may be used for diagnosis, but the FPG has the benefits of ease of testing (no waiting and better tolerated), better reproducibility and reliability, and lower cost. There is inadequate evidence to show that either test is superior. The 2-hour PG is recommended after an abnormal FPG, and, if abnormal, will lead to lower blood pressure and lipid goals compared with nondiabetic individuals. It is uncertain from current evidence whether treating asymptomatic elevated 2-hour PG or changing the cut points for impaired fasting glucose and impaired glucose tolerance will reduce mortality from cardiovascular disease, and more research is needed in this area. Pearls for Practice The cut point for FPG has been reduced from 110 to 100 mg/dL, which will increase the number of individuals diagnosed with prediabetes. There is inadequate evidence to choose between the FPG and 2-hour PG tests, and judgment may be based on test feasibility, reliability, and reproducibility. Both may be performed in any one patient to confirm diabetes diagnosis. http://www.medscape.com/viewarticle/463433 To access the article, click on this Web address, or cut and paste it into a browser window. This article notification service provided by http://www.medscape.com |
#2
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Pre-diabetes Threshold Lowered
Sounds good to me.
I wonder if they will follow suit in Australia. At the moment "pre-diabetes" is defined at an A1c of 6.5% I'm not all that certain that the FBG is a good indication of impaired glucose tolerance either. I still think that the PG is the best indicator. But I guess this IS progress. Annette "Cookie Cutter" wrote in message ... This article notification service provided by http://www.medscape.com Revised Diabetes Guidelines Lower Threshold for Impaired Fasting Glucose CME News Author: Laurie Barclay, MD CME Author: D?sir?e Lie, MD, MSEd Authors and Disclosures Release Date: October 24, 2003; Valid for credit through October 24, 2004 Oct. 24, 2003 ? An international expert committee on the diagnosis and classification of diabetes mellitus has published revised guidelines, which incorporate new data since the last report of 1997, in the November issue of Diabetes Care. Decreasing the cutoff for impaired fasting glucose from 110 mg/dL to 100 mg/dL could increase diagnoses of prediabetes by approximately 20%. "Lowering the threshold should help pick up more people who are at increased risk for developing diabetes," Committee Chair Saul Genuth, MD, from Case Western Reserve University in Cleveland, Ohio, says in a news release. "What's important about that is that we now know ? through studies such as the Diabetes Prevention Program (DPP) and the Finnish Diabetes Study ? that we can prevent or delay the progression to diabetes from impaired glucose tolerance, the original component with the term pre-diabetes, through intensive lifestyle treatment, such as exercise and diet therapy. We hope, but don't yet know, that intervening earlier might also reduce the risk of diabetic complications, including cardiovascular complications." Modest weight loss and regular exercise can prevent or delay the development of type 2 diabetes by up to 58%, based on results of the DPP and other studies. Criteria for the diagnosis of diabetes remain unchanged, and the committee recommended against using the HbA1C as a routine diagnostic test for diabetes. Although clinical evidence is currently inadequate for superiority of either the fasting plasma glucose (FPG) test or the oral glucose tolerance test (OGTT), the committee prefers the FPG because of its greater convenience and lower cost. The American Diabetes Association (ADA) recommends that individuals aged 45 years or older, especially those who are overweight or obese, be screened for diabetes/prediabetes and retested every three years if normal. Individuals at increased risk because of obesity, family history, gestational diabetes, or other recognized risk factors for diabetes should be considered for screening every few years, according to Dr. Genuth. Unanswered questions mandating further research include defining the best approach to diabetes detection, understanding the pathophysiology and risks of IPG and glucose tolerance, and determining to what extent cardiovascular risk can be lowered by starting treatment of glycemia earlier. "The answers to these and other questions will necessitate regular surveillance and reconsideration of new data that may lead to appropriate revisions to the diagnostic and classification criteria for diabetes over time," the authors write. Diabetes Care. 2003;26:3160-3167 Learning Objectives Upon completion of this activity, participants will be able to: List the changes in recommendations for the diagnosis of diabetes since the 1997 Expert Committee report of the ADA. Describe the updated criteria for prediabetes and diabetes screening. Clinical Context The 1997 International Expert Committee was convened to examine the classification and diagnostic criteria of diabetes, based on the 1979 report of the National Diabetes Data group and the World Health Organization (WHO) study group. The WHO criteria for diagnosing diabetes is FPG of 126 mg/dL or higher or two-hour plasma glucose (PG) of 200 mg/dL or higher in the OGTT after a 75 g oral glucose challenge. The criteria were adopted by the ADA in 1997. The two-hour PG has been considered the de facto "gold standard" because it is a better predictor of all-cause mortality or cardiovascular mortality than an elevated FPG value. The FPG cutoff value is based on the prediction of retinopathy beginning at approximately 126 mg/dL. Impaired glucose tolerance is defined as FPG of 110 mg/dL or higher when two-hour PG after a 75 g oral glucose challenge is 140 to 199 mg/dL. The lack of a suitable marker of diabetes has led to a reliance on metabolic abnormalities such as hyperglycemia t! o determine risk and diagnosis of diabetes. Currently, diabetes and prediabetes screening is recommended by the ADA for patients with risk factors for the disease including obesity, age 45 years or older, family history, or gestational diabetes. If the test is normal, retesting is recommended every three years. If prediabetes or impaired glucose tolerance is diagnosed, there is a higher risk of developing diabetes within 10 years and lifestyle modification is recommended. The expert committee was reconvened for this position statement to reconsider the questions of (1) cut point of the FPG and two-hour PG for diabetes diagnosis, (2) reduction of the lower limit for impaired fasting glucose from 110 mg/dL to 100 mg/dL, (3) inclusion of the HbA1C as a diagnostic criterion for diabetes, and (4) use of the two-hour PG in addition to the FPG for diagnosis of diabetes. The recommendations are based on new studies that have emerged since 1997. Study Highlights The cut point for FPG and 2-hour PG will remain unchanged from 1997. There is no consistent difference in the prevalence of diabetes across populations observed by using the 1997 criteria. Recent studies have not shown an advantage for reducing the 2-hour PG cut point to 180 mg/dL. It was noted that the 2 tests measure slightly different constructs and result in different prevalence of diabetes. In patients with a new diagnosis of diabetes, a confirmatory test is recommended after the initial test. The cut point for impaired fasting glucose was reduced from a definition of 110 mg/dL to 100 mg/dL. Impaired fasting glucose is now redefined as an FPG of 100-125 mg/dL. This is based on observations that the receiver operator characteristic curve closest to the ideal of 100% sensitivity and specificity for the glycemic range of 81-126 mg/dL was 103 mg/dL in a Dutch population, 97 mg/dL in a Pima Indian population, 94 mg/dL in a Mauritius population, and 94 mg/dL in a San Antonio population, all values below the older 110 mg/dL cut point. This proposed new definition for impaired fasting glucose will increase the number of individuals with prediabetes and thus increasing the number of people who may benefit from intensive lifestyle modification such as weight reduction and exercise to prevent diabetes onset. HbA1C is not recommended as an additional criterion for the diagnosis of diabetes. The reasons are lack of international standardization of reference ranges and the confounding effect of other conditions (such as pregnancy, uremia, hemoglobinopathies, blood transfusion, and hemolytic anemia). HbA1C is still recommended as an indicator of therapeutic response. Both FPG and 2-hour PG may be used for diagnosis, but the FPG has the benefits of ease of testing (no waiting and better tolerated), better reproducibility and reliability, and lower cost. There is inadequate evidence to show that either test is superior. The 2-hour PG is recommended after an abnormal FPG, and, if abnormal, will lead to lower blood pressure and lipid goals compared with nondiabetic individuals. It is uncertain from current evidence whether treating asymptomatic elevated 2-hour PG or changing the cut points for impaired fasting glucose and impaired glucose tolerance will reduce mortality from cardiovascular disease, and more research is needed in this area. Pearls for Practice The cut point for FPG has been reduced from 110 to 100 mg/dL, which will increase the number of individuals diagnosed with prediabetes. There is inadequate evidence to choose between the FPG and 2-hour PG tests, and judgment may be based on test feasibility, reliability, and reproducibility. Both may be performed in any one patient to confirm diabetes diagnosis. http://www.medscape.com/viewarticle/463433 To access the article, click on this Web address, or cut and paste it into a browser window. This article notification service provided by http://www.medscape.com --- Outgoing mail is certified Virus Free. Checked by AVG anti-virus system (http://www.grisoft.com). Version: 6.0.537 / Virus Database: 332 - Release Date: 6/11/03 |
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Pre-diabetes Threshold Lowered
Why do they insist on calling it pre-diabetes or impaired glucose tolerance?
Call a spade a spade: it's diabetes! Calling these other softened names just helps feed the denial machine. People need to be properly terrified. I wish I'd been more terrified 10 years ago when they said I MIGHT get diabetes. Fear is a great motivator. When you all tell the hopeful newbies that it can't be reversed - a hope they all come in with (me too!) - it's not that they can't reverse the disease. It's that they had it before they were diagnosed. They've been diabetic all along. Yes, they might reverse some of the symptoms to an earlier state (if they're early enuff). But that earlier state was also diabetic. It isn't that once you have diabetes, you will always have it! Once you have diabetes, you find out you always had diabetes.. Jon |
#4
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Pre-diabetes Threshold Lowered
"Jon Kaplan" wrote in message ... Why do they insist on calling it pre-diabetes or impaired glucose tolerance? Call a spade a spade: it's diabetes! Calling these other softened names just helps feed the denial machine. People need to be properly terrified. I wish I'd been more terrified 10 years ago when they said I MIGHT get diabetes. Fear is a great motivator. When you all tell the hopeful newbies that it can't be reversed - a hope they all come in with (me too!) - it's not that they can't reverse the disease. It's that they had it before they were diagnosed. They've been diabetic all along. Yes, they might reverse some of the symptoms to an earlier state (if they're early enuff). But that earlier state was also diabetic. It isn't that once you have diabetes, you will always have it! Once you have diabetes, you find out you always had diabetes.. Jon Jon, I'm not so sure about that. Was there a time when *I* didn't have diabetes? Taken to it's logical conclusion, what you are saying is that I was born with it. Here's how I understand the situation. Diabetes is actually defined when the condition becomes irreversable. And that usually that happens when the death of beta cells exceeds the rate of re-generation. In T1, the loss of beta cells ends up being total. In T2, it's slower, but again, seems to be irreversable. There is a line that is crossed that one cannot reverse. If however, the progression is stopped early enough, then there is a good chance that frank diabetes will never eventuate. One of the goals of science is to restore beta cells. When and if they succeed, then there will truly be a cure for diabetes. Annette --- Outgoing mail is certified Virus Free. Checked by AVG anti-virus system (http://www.grisoft.com). Version: 6.0.537 / Virus Database: 332 - Release Date: 6/11/03 |
#5
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Pre-diabetes Threshold Lowered
I'm sorry Jon, but I think I am going to have to disagree with your
statement. I have Impaired Glucose Tolerance and was diagnosed a little over a year ago. Fear **did** motivate me into dropping nearly 90 pounds. My fasting numbers are still in the IGT levels, not diabetic. I know all about complications from watching my mother die of kidney failure four years ago at the age of 68 and her father, who died of heart problems and diabetes when he as 65. My friend just lost a toe from complications. I am sufficiently terrified. My new internist pronounced me a "diet-controlled diabetic" which freaked me out a little. I asked my endocrinologist and she said I had impaired glucose tolerance, controlled by diet. Semantics? Maybe. I know that it's a matter of time before I become a member of your club, but I think my total lifestyle changes have made full-blown diabetes a little further away. I have learned so much about diabetes from visiting and posting to this newsgroup. I am just vain enough to love it when people come up to me who don't recognize me. Everybody wants to know how I lost so much weight and I do tell them I was motivated by fear of diabetes. For me Impaired Glucose Tolerance was a gift of a few extra months or years to learn how to live with the inevitable that is most likely my future. --Judy "Jon Kaplan" wrote in message ... Why do they insist on calling it pre-diabetes or impaired glucose tolerance? Call a spade a spade: it's diabetes! Calling these other softened names just helps feed the denial machine. People need to be properly terrified. I wish I'd been more terrified 10 years ago when they said I MIGHT get diabetes. Fear is a great motivator. When you all tell the hopeful newbies that it can't be reversed - a hope they all come in with (me too!) - it's not that they can't reverse the disease. It's that they had it before they were diagnosed. They've been diabetic all along. Yes, they might reverse some of the symptoms to an earlier state (if they're early enuff). But that earlier state was also diabetic. It isn't that once you have diabetes, you will always have it! Once you have diabetes, you find out you always had diabetes.. Jon |
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Pre-diabetes Threshold Lowered
On Sat, 8 Nov 2003 19:44:32 +1100, "Annette"
wrote: "Jon Kaplan" wrote in message ... [snip] It isn't that once you have diabetes, you will always have it! Once you have diabetes, you find out you always had diabetes.. Jon Jon, I'm not so sure about that. Was there a time when *I* didn't have diabetes? Taken to it's logical conclusion, what you are saying is that I was born with it. People are born with a pre disposition towards diabetes. That does not necessarily mean they will become diabetic or in fact GIT. Many do eventually but there are many who do not. There is no way of knowing - well there is but it is socialy unacceptable to genetically test a Foetus or a born child for possible 'predispositions'. Here's how I understand the situation. Diabetes is actually defined when the condition becomes irreversable. Wrong, diabetes is not reverseable. It might be better to say that it is the point at or beyond which bodily damage begins due to a malfunction of the systems that control glucose in the body. And that usually that happens when the death of beta cells exceeds the rate of re-generation. In T1, the loss of beta cells ends up being total. In T2, it's slower, but again, seems to be irreversable. There is a line that is crossed that one cannot reverse. Do tell me - what is it that can be reversed? [snip] Pete Diagnosed 20/03/03 Type II D&E + Metformin + Gliclazide + Asprin 210lbs at Dx to target 174lbs achieved. Now 171lbs. To mail: aspen3 at freeuk.com |
#7
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Pre-diabetes Threshold Lowered
Pete schrieb: [...] And that usually that happens when the death of beta cells exceeds the rate of re-generation. In T1, the loss of beta cells ends up being total. In T2, it's slower, but again, seems to be irreversable. There is a line that is crossed that one cannot reverse. Do tell me - what is it that can be reversed? Insulin resistance can be reversed, to a certain degree. If that happens while the beta cells are still undamaged, full-blown diabetes might never develop. Thorsten -- "Nothing in biology makes sense, except in the light of evolution" (Theodosius Dobzhansky) |
#8
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Pre-diabetes Threshold Lowered
All of my early life, my fasting blood sugar was around 88.
In my middle years, I saw it begin to creep up. When it started coming in at 105, I began to realize that I was heading for some serious problems. After educating myself to the glycemic index of carbs and moderating the total amount of carb I ate, my fasting blood sugar is back to 90. You could say that I still have the problem - - that if I ate the way I was eating before, then my blood sugar response would be the same. I think you are right. But I have to point out that food - - and what is considered "normal" and healthy eating - - has changed tremendously between the time my blood sugar was 88 and when it was 105. I returned to a way of eating that was closer to my eating patterns back when I was at 88. Cookie -- ############ "JCG" wrote in message ... I'm sorry Jon, but I think I am going to have to disagree with your statement. I have Impaired Glucose Tolerance and was diagnosed a little over a year ago. Fear **did** motivate me into dropping nearly 90 pounds. My fasting numbers are still in the IGT levels, not diabetic. I know all about complications from watching my mother die of kidney failure four years ago at the age of 68 and her father, who died of heart problems and diabetes when he as 65. My friend just lost a toe from complications. I am sufficiently terrified. My new internist pronounced me a "diet-controlled diabetic" which freaked me out a little. I asked my endocrinologist and she said I had impaired glucose tolerance, controlled by diet. Semantics? Maybe. I know that it's a matter of time before I become a member of your club, but I think my total lifestyle changes have made full-blown diabetes a little further away. I have learned so much about diabetes from visiting and posting to this newsgroup. I am just vain enough to love it when people come up to me who don't recognize me. Everybody wants to know how I lost so much weight and I do tell them I was motivated by fear of diabetes. For me Impaired Glucose Tolerance was a gift of a few extra months or years to learn how to live with the inevitable that is most likely my future. --Judy "Jon Kaplan" wrote in message ... Why do they insist on calling it pre-diabetes or impaired glucose tolerance? Call a spade a spade: it's diabetes! Calling these other softened names just helps feed the denial machine. People need to be properly terrified. I wish I'd been more terrified 10 years ago when they said I MIGHT get diabetes. Fear is a great motivator. When you all tell the hopeful newbies that it can't be reversed - a hope they all come in with (me too!) - it's not that they can't reverse the disease. It's that they had it before they were diagnosed. They've been diabetic all along. Yes, they might reverse some of the symptoms to an earlier state (if they're early enuff). But that earlier state was also diabetic. It isn't that once you have diabetes, you will always have it! Once you have diabetes, you find out you always had diabetes.. Jon |
#9
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Pre-diabetes Threshold Lowered
"JCG" wrote in message ... I'm sorry Jon, but I think I am going to have to disagree with your statement. I have Impaired Glucose Tolerance and was diagnosed a little over a year ago. Fear **did** motivate me into dropping nearly 90 pounds. My fasting numbers are still in the IGT levels, not diabetic. I know all about complications from watching my mother die of kidney failure four years ago at the age of 68 and her father, who died of heart problems and diabetes when he as 65. My friend just lost a toe from complications. I am sufficiently terrified. My new internist pronounced me a "diet-controlled diabetic" which freaked me out a little. I asked my endocrinologist and she said I had impaired glucose tolerance, controlled by diet. Semantics? Maybe. I know that it's a matter of time before I become a member of your club, but I think my total lifestyle changes have made full-blown diabetes a little further away. I have learned so much about diabetes from visiting and posting to this newsgroup. I am just vain enough to love it when people come up to me who don't recognize me. Everybody wants to know how I lost so much weight and I do tell them I was motivated by fear of diabetes. For me Impaired Glucose Tolerance was a gift of a few extra months or years to learn how to live with the inevitable that is most likely my future. --Judy I hope you never get there (become truly diabetic). I wish you all the best for your future. Whatever happens. Annette --- Outgoing mail is certified Virus Free. Checked by AVG anti-virus system (http://www.grisoft.com). Version: 6.0.537 / Virus Database: 332 - Release Date: 6/11/03 |
#10
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Pre-diabetes Threshold Lowered
On Sat, 08 Nov 2003 21:23:13 +0100, Thorsten Schier
wrote: Pete schrieb: [...] And that usually that happens when the death of beta cells exceeds the rate of re-generation. In T1, the loss of beta cells ends up being total. In T2, it's slower, but again, seems to be irreversable. There is a line that is crossed that one cannot reverse. Do tell me - what is it that can be reversed? Insulin resistance can be reversed, to a certain degree. If that happens while the beta cells are still undamaged, full-blown diabetes might never develop. Thorsten I think you are getting two words mixed up. Reverse and Reduced. Pete Diagnosed 20/03/03 Type II D&E + Metformin + Gliclazide + Asprin 210lbs at Dx to target 174lbs achieved. Now 171lbs. To mail: aspen3 at freeuk.com |
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