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There’s an epidemic of prediabetes in the United States: 84 million Americans have this condition but most don’t know it. Prediabetes puts an individual on track for developing full-blown diabetes in five years. Although simple strategies can derail that train, one of them — nutrition counseling — is missing.

I worry that without preventive efforts like counseling about nutrition and other lifestyle choices, many people will unnecessarily make the journey from prediabetes to diabetes. And that would be a shame.

Here’s the issue: While most insurance plans cover nutrition counseling for people with diabetes, it isn’t covered for those with prediabetes. That flies in the face of research documenting that lifestyle counseling is an effective way to halt the steady progression of prediabetes to diabetes and reduce the long-term costs associated with treating the complications like heart attacks and limb amputations that diabetes inflicts.


Here’s the solution: The U.S. House and Senate have recently introduced the bipartisan Preventing Diabetes in Medicare Act. It would cover medical nutrition therapy counseling for Medicare recipients with prediabetes. If passed, the law would likely force private health insurance providers to also cover the cost of counseling for those with prediabetes.

The damage of diabetes

Diabetes is one of the top seven leading causes of death among Americans. That may be a bit of an underestimate, since having it confers a double whammy: individuals with diabetes are also at risk for heart disease, the No. 1 killer of Americans. In shopping terms, this is a BOGO sale — buy one, get one free — gone very, very wrong.


Here’s the science behind the disease: Your body depends on a particular type of sugar, glucose, that it extracts from the foods you eat or regenerates from starch stored in the liver. In fact, your brain, nervous system, and red blood cells depend heavily on glucose to function properly.

Normally, the body relies on the hormone known as insulin to usher glucose out of the bloodstream and into cells. But when cells lose the ability to respond to insulin’s “open up for glucose” signal, or the production of insulin falters, glucose builds up in the bloodstream. Too much blood sugar is the hallmark of prediabetes and diabetes. Over time, a high level of blood glucose can damage:

  • the nervous system, causing chronic pain, tingling, and the loss of feeling in the feet and lower legs.
  • the eyes. Diabetes-related eye disease is the leading cause of impaired vision and blindness among adults.
  • the kidneys, often leading to kidney failure and the need for dialysis.
  • the heart and arteries. Diabetes is a significant risk factor for heart attack, stroke, peripheral artery disease, and other cardiovascular problems.

People with prediabetes have higher-than-normal levels of blood sugar, but not high enough to be classified as diabetes. Being overweight increases the risk of developing prediabetes, as do eating an unhealthy diet and physical inactivity. The hazard of prediabetes isn’t just that it might lead to diabetes. Individuals with it are also at a higher risk of developing heart disease and stroke, even if they don’t yet have full-fledged diabetes.

Prevention is key

The good news is that diabetes-related health complications can be minimized — and even prevented — by adopting a healthy, well-balanced diet and participating in regular physical activity that maintains your blood glucose level in a normal or close-to-normal range.

The landmark Diabetes Prevention Program demonstrated that losing a minimum of 7 percent body weight, coupled with 2 ½ hours of brisk walking or other similar type of physical activity a week, could reverse prediabetes or at least delay the onset of diabetes. The folks in that study received personalized counseling about their diet, physical activity, and lifestyle behaviors to achieve these weight loss and activity goals. Follow-up research confirmed that this type of personalized counseling was more cost-effective over the long haul than just dispensing medication to lower blood sugar without making these lifestyle changes. In other words, taking a pill isn’t going to cut it. What’s needed are positive changes in diet and lifestyle.

The American Diabetes Association recommends that individuals with diabetes receive individualized medical nutrition therapy, preferably by a registered dietitian knowledgeable in this area, to help them clean up their diets and get off the couch. Luckily, this type of personalized nutrition counseling is covered by most health insurance plans. The association also supports the same approach, and insurance coverage, for those with prediabetes.

While the Preventing Diabetes in Medicare Act is a no-brainer, it may not be passed without public support. Consider contacting your representatives in the House of Representatives and the Senate and telling them you support this bill. Americans could be a co-pay away from getting a handle on diabetes by taking care of prediabetes.

Joan Salge Blake is a clinical associate professor in the nutrition program at Boston University. She has received funds from General Mills and Mars for conference travel and for providing an educational webinar for nutrition and fitness professionals.

  • Diabetes is a very disease and today there are maximum number of people who are suffering from diabetes.

    In case, if any one feels that the diabetes is hereditary then they should take care about their health by taking more precautions.

    And, such cases are not only occurring in America, but worldwide the majority of people has got infected.

    So, instead of becoming a patient of Diabetes, it will better to take appropriate precautions.

    Very informative post!!!

    Mark Bradley

  • Five years ago, after several years of creeping up on the magic blood sugar number of 125, the doctor pronounced me a diabetic and sentenced me to diabetes school and medication for the rest of my life. As a Mercola devotee, instead I found a paleo nutritionist who had herself reversed Type 2 diabetes, and by eliminating sugar and grains (sweeping) from my diet I was able to drop my blood sugar to a normal level in less than 6 months. Since then I enjoy hearing from my new doctor every 6 months that my blood sugar and A1c are “excellent”, along with a host of other improvements in my blood work numbers. Don’t fool yourself, the epidemic of Type 2 Diabetes is the result of the SAD (standard American diet), processed food, sugar and grains.

  • Diabetes is a devastating illness. We know that our lifestyle contributes to contracting this illness and that lifestyle changes can forestall or prevent it. While taking medication may be an easier approach, medications are expensive and often have unforeseen side effects. We are fortunate to have prediabetes as a warning sign enabling people to change their eating habits before contracting a more serious condition. Nutrition counseling should be supported by government and private insurance plans as an effective approach to a devastating condition.

  • What always seems to be missing in these discussions is recognition of how challenging change is for so many who are probably at the highest risk of pre- and diabetes: low income, low health literacy, and marginalized peoples, to name but a few. You can tell them what’s healthy all day til you’re blue in the face, and they’ll often agree, and be polite and try to respond affirmatively to please the dietitian/health counselor. But at the end of the day, they face REAL BARRIERS to making the “simple changes” these counselors espouse. Change isn’t simple when you scrimp and scrape to eat at all, when you must work two jobs to do so, and/or when you’ve got other serious stressors and health concerns (e.g. chronic pain, mental illness, addiction, arthritis, cancer) gnawing away at your well-being. Some of these folks live in food deserts; some of these folks don’t honestly understand or care about what the heck we’re talking about; a LOT of these folks are 65+ years old and feel they’ve made it this far doing what they’re doing – why change now? Like ’em or not, these are (a few of probably 1000) real barriers to change for a VAST majority. Failing to recognize – let alone address – real life challenges to change is gonna wasted a lot of precious time and resources.

  • Dr. Blake,
    Thank you for increasing awareness about pre-diabetes and diabetes. Your article is very well written. Prevention is key and you are absolutely on target with identifying registered dietitian nutritionists as the medical professional to help people with pre-diabetes manage their condition. You are correct; we have the research showing healthy lifestyle habits (150 minutes of physical activity per week and following a healthy eating plan) can make a huge difference. If we have the tools and resources to prevent pre diabetes from escalating to type 2 diabetes, why wouldn’t we use these identified cost saving avenues? Screening for type 2 diabetes should be added to the docket too. Many people don’t get diagnosed with type 2 diabetes until possibly 10 years later- damage to organs have already begun. I’m in total agreement for complete insurance and Medicare coverage for people with pre-diabetes.

  • Excellent overview regarding “prediabetes” and its prevention. Prediabetes is a bit of a misnomer as many patients classified as such will, and have already progressed to treatable disease. The salient message contained in this article regarding nutritional modification and education (along with physical activity) would directly ameliorate the inexorable march towards Type 1 and 2 AODM. Notwithstanding genetic predisposition, Dr. Blake provides a compelling argument for nutritional intervention to stem the tide of domestic and global prevalence of diabetes. Not to be an alarmist, as an eye care practitioner in a multi-office group practice, nearly 20% of my patient base consists of early or more advanced onset of diabetic retinopathy. Clearly, we are reaching a level of diabetic diagnosis approaching pandemic levels. Nutritional education and training is a crucial component to reversing the trend. Thanks to Dr. Blake for providing her professional insight!

  • Thank you Dr. Joan Salge-Blake. I agree that prevention is so much cheaper than disease treatment, especially when we have cost-effective, evidence-based therapy ready to be delivered by Registered Dietitian Nutritionists in a variety of settings. The staggering medical costs associated with diabetes, and the long list of painful complications, are just the tip of the iceberg. If we also consider increased absenteeism, lost productivity, disability, poor quality and premature loss of life, this is the easiest health care policy decision to make. Let’s reach out to our representatives. A healthier lifestyle offers the added benefits of improved blood pressure, lipid levels, bone health, mental health, and reduced risk of many cancers.

  • Thank you to the author for writing this very important article! Diabetes prevention should be on every American’s and certainly every representative and senator’s mind as we continue to see our nation in a healthcare crisis of chronic preventable disease. As outlined above type 2 diabetes has many side effects that eventually can require very expensive medical interventions. Medicare and private insurance companies would be smart to pay for preventive care for diabetes as well as other chronic diseases under the guidance and couseling of a registered dietitian nutritionist. Dietitians are trained healthcare professionals that can encourage and reinforce long term behavior change.

  • Thank you for this call to action! We know in life that an ounce of prevention is worth a pound of cure (weight-related pun intended), and this is especially true regarding nutrition. The earlier and more frequently conversations about nutrition and its far-ranging impact on all aspects of our health, the better. This is an investment everyone should agree on.

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