Friday, February 23, 2007

Changing thresholds

In the past few years, lab work that used to be 'normal' is now redefined risky. In particular, fasting blood sugar was considered normal up to 110, but the new acceptable cut-off has dropped to 99. Fasting blood sugars 100-125 are now considered 'prediabetes' or 'impaired fasting glucose (IFG).'

This down-graded normal threshold is based on population studies that show risk of diabetes and heart disease rises significantly in persons with these low level elevations. A new study from the State University of New York at Buffalo confirms that prediabetes, like prehypertension (see previous post) is definitely pretrouble.

Investigators there looked at women who developed abnormal fasting blood sugars over a six year period while participating in the Western New York Health Study. Blood samples collected and frozen at the start of the study were pulled out for re-examination after the IFG diagnosis was made, comparing these results with those from control subjects who did not become prediabetic. The samples were checked for endothelial markers--tests that indicate an active inflammatory process occurring in the blood vessel wall which, in turn, greatly increases the risk of coronary artery disease.

Not only did prediabetics have significantly elevated endothelial markers before they ever manifested any blood sugar abnormality, the women with elevated fasting sugars had more abnormal baseline tests of blood vessel inflammation than did the prediabetic men. The researchers theorized that this may explain why diabetic women are known to have a higher risk of heart disease than diabetic men.

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