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What Is The Difference? - Page 2


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Old 03-27-2016, 06:34   #11
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Quote:
Originally Posted by smorgan View Post
Was this a typo?
If you're referring to the liver cancer, no. It is the only cancer that has a risk inversely associated with A1c levels. Click through the link to the free full text versions.


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Originally Posted by smorgan View Post
Also, the observational study needs a lot more to mean much. A significant number of people with those "mid" A1Cs would have been under medical "care" - else how would we even know about them? And so many of those would have been taking beta blockers, statins and who knows what else. These things are routinely prescribed pre-emptively even without any actual disease. The statistic cited alone means about nothing without controlling for such things.
While a single study is not something I would freak out about, the weight of the data seems to me to support recognition that pre-diabetes is not an innocuous condition. I merely provided links to the two most recent studies I'm aware of in this trend.

As I said, YMMV - but personally, I don't think believe that diabetes/not diabetes is binary - or even trinary (diabetes/pre-diabetes/normal). The demarcations are just arbitrary cut-offs with the risks on the diabetes side of the line just a hairsbreadth higher than the risks on the pre-diabetes or non-diabetes side of the line. If I had been diagnosed with prediabetes, I'd be treating it rather than merely watching it - because I'd rather treat and be wrong about the risk than not treat and be right.

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Old 03-27-2016, 09:09   #12
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If you're referring to the liver cancer, no. It is the only cancer that has a risk inversely associated with A1c levels. Click through the link to the free full text versions.




While a single study is not something I would freak out about, the weight of the data seems to me to support recognition that pre-diabetes is not an innocuous condition. I merely provided links to the two most recent studies I'm aware of in this trend.

As I said, YMMV - but personally, I don't think believe that diabetes/not diabetes is binary - or even trinary (diabetes/pre-diabetes/normal). The demarcations are just arbitrary cut-offs with the risks on the diabetes side of the line just a hairsbreadth higher than the risks on the pre-diabetes or non-diabetes side of the line. If I had been diagnosed with prediabetes, I'd be treating it rather than merely watching it - because I'd rather treat and be wrong about the risk than not treat and be right.
I agree with your personal approach and it's mine, too. But, what you have cited is an observational study. Without controlling for confounders, it means pretty much exactly nothing. It is not even step one, more like step 0.

Especially in this case where there are some extremely obvious possible confounders like what I mentioned. So, it may be a "lead" to be followed up, but it is meaningless in and of itself. I'm sure you could find all kinds of healthful correlations with gym memberships - even if some of them never set foot in the gym. Why? Because its a pointer to general "concern about health" which would be accompanied by OTHER things yielding health benefits.

And no, it is not just a continuum. There is a point between what is "high normal" and what is diabetes. It's just that 1) we don't know what it is due to insufficient data and 2) it may not be the same across individuals.

So, what is truly "a little high but not diabetes"? It is levels that non-diabetic people can reach but it stops there (or perhaps always WAS there). It doesn't keep going up and they live their entire lives without becoming "truly" diabetic. That is certainly not diabetes.

On the other hand, another person may have those same numbers but are ON THE WAY UP. Within a few years, they enter the "frank diabetes" zone and get their official Dx.

We don't have enough data to find our way through this. We'd have to track a lot more people not just DURING D or Pre-D but before an after as well in order to parse this out.

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Old 03-27-2016, 15:59   #13
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Quote:
Originally Posted by smorgan View Post
I agree with your personal approach and it's mine, too. But, what you have cited is an observational study. Without controlling for confounders, it means pretty much exactly nothing. It is not even step one, more like step 0.

Especially in this case where there are some extremely obvious possible confounders like what I mentioned. So, it may be a "lead" to be followed up, but it is meaningless in and of itself. I'm sure you could find all kinds of healthful correlations with gym memberships - even if some of them never set foot in the gym. Why? Because its a pointer to general "concern about health" which would be accompanied by OTHER things yielding health benefits.

And no, it is not just a continuum. There is a point between what is "high normal" and what is diabetes. It's just that 1) we don't know what it is due to insufficient data and 2) it may not be the same across individuals.

So, what is truly "a little high but not diabetes"? It is levels that non-diabetic people can reach but it stops there (or perhaps always WAS there). It doesn't keep going up and they live their entire lives without becoming "truly" diabetic. That is certainly not diabetes.

On the other hand, another person may have those same numbers but are ON THE WAY UP. Within a few years, they enter the "frank diabetes" zone and get their official Dx.

We don't have enough data to find our way through this. We'd have to track a lot more people not just DURING D or Pre-D but before an after as well in order to parse this out.
We'll have to agree to disagree, both as to the meaning of the studies & whether diabetes is binary or a continuum.

I do agree that many people will run high on the markers we currently use to determine whether someone has diabetes - and never develop it. I just think it is a disease that is much more complex than can be defined as present or not.

I also agree that correlation is not causation. In this case I don't have access to the full article, so I can't debate you point for point about what observational data was gathered and what it might or might not ean. As I noted, though, it is one more in a trend is that suggests that prediabetes, as it is currently defined, is not as innocuous as the medical community would have us believe.

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Old 03-31-2016, 18:08   #14
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I read an article this morning that helped define the difference between pre-diabetes and type 2 diabetes.

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"The distinction between pre-diabetes and Type 2 diabetes is one of degree. Pre-diabetes is “moderate” insulin resistance, while Type 2 diabetes is “extreme” insulin resistance.

The problem is, with any degree of insulin resistance, blood glucose stays elevated and can damage blood vessels, especially smaller vessels (the micro-circulation). This damage prevents the delivery of oxygen and nutrients to cells which can lead to dire complications like blindness and amputation. The combination of high glucose and high insulin concentrations in the blood also can cause high blood pressure and acceleration of clogging of the arteries (atherosclerosis)." Why doctors ignore pre-diabetes in boomers

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Old 03-31-2016, 22:13   #15
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I read an article this morning that helped define the difference between pre-diabetes and type 2 diabetes.
This is so true Cricket...yesterday I saw a doctor about my UTI. When I started asking some questions about my pre-diabetes she said Pete you don't need to worry, you're only pre-diabetic, you don't need to be testing your blood, really you're okay. It's hard to believe the medical community doesn't take this more seriously. As your article pointed out 1/3 of patients diagnosed with pre-diabetes developed type 2 diabetes with in a five year period. I just don't get it?

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Old 03-31-2016, 23:12   #16
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This is so true Cricket...yesterday I saw a doctor about my UTI. When I started asking some questions about my pre-diabetes she said Pete you don't need to worry, you're only pre-diabetic, you don't need to be testing your blood, really you're okay. It's hard to believe the medical community doesn't take this more seriously. As your article pointed out 1/3 of patients diagnosed with pre-diabetes developed type 2 diabetes with in a five year period. I just don't get it?
I don't understand these doc's relaxed attitudes either. Mine didn't seem concerned, advised me to check out the ADA guidelines and told me she didn't find it necessary to test myself at home. That will be $140 please and I'll see you in 3 months!!

Had I not found this group, I would not know any difference. Just in testing after foods that I normally eat, I have seen my level reach 299 and she would never know this because my A1C at my 3 month visit isn't going to show her that.

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Old 04-01-2016, 10:48   #17
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My wife's been "pre-diabetic" for something like 15 - 20 years and still not diabetic. I try to get her to be a little more concerned than she tends to be and we're keeping an eye on it. But, 15 years is a long time. She might just be a TRUE "pre-diabetic". She might even live out her life without ever becoming "diabetic". We really can't rule out that there could be such a thing.

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DX: 9/2009 A1C=10.7
A1C 2/2010: 6.7 (DX + 4 months)
A1C 5/2010: 6.0 (DX + 8 months)
A1C 8/2010: 5.7 (DX + 11 months)
A1C 11/2010: 5.1 (DX + 14 months)
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A1C 7/2012: 5.5 (DX + 2 years 10 months)
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Old 04-01-2016, 14:50   #18
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My sister was 'pre-diabetic' for 1-1/2 years, did not 'watch' her diet nor her blood sugar in spite of advice from myself and her doctor. Now she is full blown type 2 diabetic. Just my opinion but doctors are doing their patients a dis-service by labeling them 'pre-diabetic'. That is like telling a woman "you're a little bit pregnant."

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Old 04-01-2016, 15:56   #19
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My sister was 'pre-diabetic' for 1-1/2 years, did not 'watch' her diet nor her blood sugar in spite of advice from myself and her doctor. Now she is full blown type 2 diabetic. Just my opinion but doctors are doing their patients a dis-service by labeling them 'pre-diabetic'. That is like telling a woman "you're a little bit pregnant."
Can be, but maybe not ALWAYS, as my example clearly shows. Nothing wrong with the label. By itself, it doesn't necessitate bad advice. It's the advice of many doctors which is bad, not the label. Although we may have more to learn, the label is IMO perfectly valid.

Calling every FBG of 101 or more "diabetes" is very likely not true at the time it's measured and may NEVER be true for the rest of that person's life. Especially if we don't know their history, which we almost never do.

For example if their FBG had been 83 their whole life and then went above 100 suddenly, perhaps more cause for concern. But, what if it had always been around 100? A young, healthy and CLEARLY non-diabetic or "pre-" son of mine measured his FBG for three weeks straight. Every reading was 92 - 98. That was 5 years ago and still no sign of D whatsoever.

Calling a non-diabetic state - when we don't know if it is the beginnings of the slide into actual diabetes OR a normal, stable and healthy state - "diabetes" doesn't add anything constructive.

As I said: Pre-diabetes should be WATCHED carefully, Diabetes should be TREATED. That fact that someone had pre- and failed to watch it carefully merely proves my point.

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66 Years
DX: 9/2009 A1C=10.7
A1C 2/2010: 6.7 (DX + 4 months)
A1C 5/2010: 6.0 (DX + 8 months)
A1C 8/2010: 5.7 (DX + 11 months)
A1C 11/2010: 5.1 (DX + 14 months)
A1C 9/2011: 5.6 (DX + 2 years)
A1C 7/2012: 5.5 (DX + 2 years 10 months)
A1C 1/2019: 5.5
Diet: Approximately C:10;P:15;F:75 (as % calories)
Exercise: Not much. Stairs at home & work.
NO MEDS, No Highs, No Lows
Grandkids: 22

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Old 04-02-2016, 15:43   #20
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I like to think of Pre-diabetes as a start down that nasty road to become a full blown diabetic.

In the "pre" stage it will be easier to manage and possibly reverse, some may use the word cure. If you start down that road, it means you have metabolic issues. Pre-diabetes is diabetes but to a lesser degree, and while being a serious health concern, it in and of itself is not to the point where it is damaging to other parts of the body. This is the time to get serious with dietary changes and try to bet normal BG with management.

One marker for Pre-diabetes is an A1c above 5.6. Heart disease is progressively increased for an A1c above the mid 4% level.

Once your A1c is brought down to normal non-diabetic levels by diet, fasting, exercise and without drugs, some will say you are cured. If that's what you choose to call it, the cure will only last as long as you continue the good behavior that helped you achieve normal BG levels. If you revert you your original lifestyle and eating, your metabolic syndrome and pre-diabetes will return.

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