What’s Your Diabetic Risk Score?

20111105-103037.jpgDiabetes has become a major health concern in the United States with a significant increase in prevalence, resulting in serious health complications regarding morbidity and mortality. The cost of healthcare in the United States is rapidly rising regarding diabetic care. Over 20 million Americans are thought to have insulin resistance, which precedes the onset of diabetes. Please see my recent blog entitled “The Down and Dirty of Diabetes”. Testing is now available to determine your diabetic risk in giving a score which can be utilized in treatment plans to prevent the onset of diabetes.

I’d like to discuss with you the pre-DX or diabetes risk score test now available. Since diabetes is a disease which is related to inflammation and oxidative stress within the body, measuring some of the stress factors and hormones can give a precise calculation of the likelihood to develop diabetes in the future. This testing is indicated for patients who are not yet diabetic but may have risk factors that lead to the onset of diabetes. Some of these risk factors include obesity, heredity, underlying thyroid disease, lack of exercise, and advancing age. After obtaining basic blood work, the recommendation of pre-DX testing may be necessary. When I look at my patients metabolic profile, if they’re fasting blood sugar becomes elevated between 100 and 125mg/dl, or their two-hour postprandial glucose is between 140 and 200mg/dl, further testing is necessary. I also consider patients with a BMI (your weight in relation to your height) of greater than 27 who have a family history of diabetes to be a candidate for this testing. I look at blood pressures that are greater than 130/85 as additional risk, or patients currently being treated with antihypertensive therapy. Lipid analysis is also important as elevated triglycerides, elevated total cholesterol, and elevated LDL are risk factors as well. Anyone who has metabolic syndrome which includes hypertension, hyperlipidemia(high cholesterol), obesity, or impaired fasting glucose are candidates for pre-DX testing. A common blood test utilized to assess the stability of blood sugar is the HgbA1c. When this level begins to climb, usually above 5.8, you have pre-diabetic risk. Levels above 6.5 usually indicate that one already has diabetes.

Pre-DX testing gives you a calculated risk score on a scale of 1 to 10. A lower score is associated with a lower risk of developing diabetes. As the risk score increases, further testing is necessary. High risk scores are correlated to a score of 8 to 10, and aggressive nutritional and exercise intervention is necessary to prevent the onset of diabetes. Interventional methods and follow-up varies according to the risk score of each patient. The risk score is calculated on the basis of underlying biomarkers. The first biomarker we look at is glucose levels at a fasting state. Fasting glucose of greater than 100 mg/dL, increases your risk of developing diabetes by as much is 70 to 80%. HgbA1c is also considered a risk factor as this increases when the glucose in our bloodstream fluctuates. There is concern when the HgbA1c is greater than 5.7. Fasting insulin is also an important measurement. Before glucose becomes abnormal, insulin rises in the bloodstream to keep glucose under control. In the initial phases of pre-diabetes, fasting insulin levels are often reported elevated. I am concerned with fasting insulin levels greater than 10 uIU/ml. Adiponectin is a hormone secreted by healthy fat cells that increases insulin sensitivity. High levels of adiponectin protect against the development of type II diabetes. Adipopnectin levels below 5.2 mcg/mL, increases your risk of diabetes. Ferritin is an iron binding protein that when consistently elevated, corresponds to the risk of developing type II diabetes. C-reactive protein is a marker of systemic inflammation. Since diabetes is an inflammatory disease, persistent elevation of CRP is a strong indicator of future diabetic developement. I’m often concerned with levels greater than 2 mg/L. Interleukin 2-Receptor Alpha (IL-2Ralpha) is a fragment of the receptor for the pro-inflammatory marker interleukin-II. This is also an indication of inflammation that may lead to the development of type II diabetes. After complete analysis of all these biomarkers, a risk score is given to each patient. This can then be utilized to develop a systematic and comprehensive approach in the treatment of glucose metabolic derangements. Certainly with the available testing that we have today, early intervention is not only critical, but essential in reducing the impact of this dreadful disease. If you or your loved ones have any of the risk factors listed above, consider further testing and obtain your pre-DX score. You can change the direction of your future health!

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