What nurses need to know about obesity and prediabetes

Diabetes is on the rise in the U.S. According to a 2014 report from the U.S. Centers for Disease Control and Prevention (CDC), as of 2012, 9.3 percent of the country’s population was living with the disease, a total of 29 million people. As life expectancies continue to climb and access to care improves, addressing chronic conditions, such as diabetes, is becoming a growing priority of the health care field. Not only are these diseases debilitating for patients, but they also take a toll on the nation’s health care system.

“These new numbers are alarming and underscore the need for an increased focus on reducing the burden of diabetes in our country,” said Ann Albright, Ph.D., R.D., director of the CDC’s Division of Diabetes Translation. “Diabetes is costly in both human and economic terms. It’s urgent that we take swift action to effectively treat and prevent this serious disease.”

While the number of people living with diabetes is high, the number at risk of developing the disease is even higher. According to the same CDC report, nearly three times as many people have the early signs of diabetes — commonly known as prediabetes — and likely will develop the disease if they do not make lifestyle changes.

To provide the best possible care for prediabetic patients and to help avoid onset of the disease, nurses need to understand the important link between the condition and weight management.

The relationship between obesity and diabetes

When it comes to preventing the development of diabetes, maintaining a healthy weight is critical. According to the National Institutes of Health (NIH), obesity specifically increases the risk of Type 2 diabetes, along with other health concerns such as heart disease and hypertension. As opposed to Type 1, which generally develops in juveniles, Type 2 typically occurs during middle age or later in life. The NIH reported that the condition usually begins with insulin resistance, which makes the pancreas work harder than usual to produce more of the hormone to regulate blood sugar levels. Eventually, the pancreas is unable to keep up with the demand and the body does not produce enough insulin when blood sugar levels rise.

The link between obesity and diabetes is not entirely understood, but what is known is that extra weight puts additional stress on the body’s ability to use insulin to regulate blood sugar, according to The Obesity Society, a nonprofit organization dedicated to promoting research about obesity and reducing stigma around the condition.
Consequently, weight management is important for individuals who have elevated blood sugar levels, as reducing excess fat may help to prevent onset of the actual disease. Research from the University of California, Los Angeles (UCLA) reveals that more than one in three people in the U.S. qualify as prediabetic.

“The rates are very high, surprisingly high,” said co-author Susan Babey, Ph.D., a UCLA Center for Health Policy Research senior research scientist. “We’re very concerned about the rates among the young adults because of their increased risk of developing Type 2 diabetes, which sets them on this path for some serious complications in the future.”

By getting their health under control and preventing the onset of diabetes, patients can avoid many health complications that can result from the disease, such as skin, eye and nerve problems.

The information nurses need to know

It is important for nurses to be able to identify patients with signs of prediabetes in order to act before Type 2 diabetes develops. As obesity is one of the most common risk factors, monitoring the blood sugar levels of these patients is key. Patients who are classified as overweight also should be watched closely.

While nurses always should be aware of the risk of diabetes when dealing with obese patients, they should be vigilant especially when weight problems are combined with other risk factors. These other factors for prediabetes and Type 2 diabetes, according to the CDC, include:

• Age (more than 45 years old)
• Lack of physical activity
• Family history of diabetes
• Instances of gestational diabetes while pregnant

Individuals of African-American, Asian-American, American Indian, Hispanic/Latino or Pacific Islander heritage also have higher instances of prediabetes and Type 2 diabetes.

The way to guide patients toward better health

Weight management is an important way to treat both prediabetes and diabetes. The American Journal of Nursing reported that people who are at risk for Type 2 diabetes may be able to delay the disease or prevent it entirely through changes to their diet and activity level. According to The Obesity Society, studies have shown that in high-risk adults, weight loss of 5 to 10 percent can delay the onset of diabetes or prevent it altogether. Adopting a more active lifestyle to reach these modest goals can significantly improve the health of a prediabetic patient.

Consequently, nurses may be able to improve outcomes by working with patients to create a plan for their diet and exercise.

However, the Mayo Clinic emphasizes that it is important to avoid fad diets and to simply make healthier decisions when it comes to eating. Your patients may be tempted by the latest trends that promise quick weight loss, but such methods rarely are effective in the long term. More importantly, the Mayo Clinic notes that these quick — and often temporary — weight drops have not been proven to help prevent diabetes. Instead, encourage sustainable changes that your patients will be able to maintain, such as taking daily walks and substituting fresh fruit for sugary desserts.

While there is much that can be done to prevent the onset of diabetes in obese patients, nurses also need to recognize when the condition exists. According to the NIH, signs and symptoms of diabetes include:

• Frequent urination
• Slow-healing sores
• Unintentional weight loss
• Numbness in the feet
• Excessive thirst
• Itchy, dry skin
• Exhaustion
• Feelings of hunger
• Blurred eyesight

If you believe that a prediabetic patient has developed Type 2 diabetes, a more aggressive treatment plan will need to be developed. The disease can be diagnosed through a fasting blood glucose test (FBG) or the oral glucose tolerance test (OGTT). The American Diabetes Association recommends the FPG because it is easier, faster and less expensive to perform. According to the New York State Department of Public Health, a FBG level between 100 and 125 mg/dl is a sign of prediabetes, while a level of 126 mg/dl or higher may signify the onset of diabetes.