With 21 million U.S. residents now officially diagnosed as having diabetes, healthcare professionals are looking at another statistic that is causing them many a sleepless night: The Centers for Disease Control estimate that there are 57 million people with pre-diabetes in the United States. (Pre-diabetes is defined as impaired fasting glucose of 100 to 125 mg/dl, impaired glucose tolerance of 140 to 199 mg/dl, or both.)

According to an American College of Endocrinology (ACE) task force, about 6 to 10 percent of patients with impaired glucose tolerance develop diabetes each year, while 60 percent of patients who have both impaired fasting glucose and glucose tolerance develop diabetes within six years. 

In response to these statistics, healthcare providers are starting to reach a consensus:  Treating pre-diabetes should be a pull-out-all-the-stops effort that rivals the aggressiveness with which they currently treat newly diagnosed cases of diabetes. 

The five main elements of this assertive approach to pre-diabetes include:

• Routine administration of the A1c test to patients to detect abnormal levels of glucose or glucose resistance
  
• Adoption of the ACE recommendation that doctors prescribe metformin and acarbose to control glucose levels in pre-diabetics before they get out of control
  
• Implementation of a further recommendation that pre-diabetics meet the same lipid and blood pressure targets that apply to diabetics who are using statins, ACE (angiotensin-converting enzyme) inhibitors, and angiotensin receptor blockers
  
• At least 30 minutes daily (150 minutes per week) of brisk walking, or an aerobic equivalent, for its proven ability to lower blood sugar levels and blood pressure 
  
• Weight loss of 5 to 10 percent-even small losses can have a profound effect on blood glucose levels and tolerance 
  
• Dietary changes, including a reduction in the consumption of alcohol and carbohydrates, especially carbs high on the glycemic index

The first two elements are a significant departure from current standard treatment. Most doctors have relied in the past on fasting tests for glucose, but have come to realize that many patients do not fast correctly or are subject to blood glucose spikes that a one-time test simply can't reveal. Because the A1c gives a reading over a 90- to 120-day period, it is a far more accurate diagnostic tool.

Many doctors have prescribed metformin to non-diabetic patients to assist with liver function or to address high glucose levels caused by other factors. The addition of acarbose (manufactured by Bayer and called "Precose" in the United States and "Glucobay" in Europe) slows the absorption of sugars and starches into the system and also suppresses appetite. Together, these drugs provide a one-two punch against high BG levels by lowering the amount of glucose the body produces as well as the speed with which it absorbs it.   

The recommendation that people with pre-diabetes meet the same blood pressure and lipid level goals as diabetics means that doctors may soon begin prescribing cholesterol and blood pressure control drugs without waiting for a diagnosis of diabetes.

These more aggressive approaches are intended to delay-perhaps even totally prevent-the onset of diabetes. Given the many harmful and costly side effects that come with diabetes, healthcare professionals are coming to believe that several pounds of prevention are worth a ton of cure.