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Leigh Perreault Part 5, Pre-Diabetes Treatment

In part 5 of this Exclusive Interview, Dr. Leigh Perreault talks with Diabetes in Control Medical Editor Joy Pape during the ADA meeting in San Diego, California, about her focus on healthy living and other possible treatment options in her discussions with frustrated prediabetes patients.

Dr. Leigh Perreault is an associate professor of medicine, physician and clinical researcher at the University of Colorado Denver School of Medicine, Aurora, CO. Her research interests include understanding the different pathways by which people develop type 2 diabetes, developing tailored strategies for diabetes prevention and the human microbiome.

Transcript of this video segment:

Joy: For your patients who have prediabetes, do you teach “eat less, exercise more”? What else do you teach?

Dr. Perreault: I absolutely do talk to my patients about healthy eating and increased physical activity because I feel like I would be remiss if I didn’t talk to them about that.  I truly believe that eating healthy and exercising more are the foundations of health for all people, regardless of where they are, what their blood sugars are, where their bone density is, all their other medical problems. But most of my patients, when they’re coming to me, they have already been told to eat less and exercise more, and if they knew how to do that and make it work, they would have done it. When they come to me I’m educating them about other potential possibilities for them. In prediabetes, there are consensus guidelines saying that you can use medications that have been historically used in diabetes, things like metformin, for the prevention of diabetes. There was a recent article in Diabetes Care that looked at the use of metformin in people with prediabetes and showing that only 0.7% of people with prediabetes in the United States are treated with metformin, so the uptake is very low. I also talk to my patients about weight loss medications or even weight loss surgery depending on where they are in life. If they have a large enough body mass index and a lot of health problems related to their weight, I think that everything is on the table for them, I put everything on the table because my job is to help them and so I don’t want to not give them options for that. Weight loss medications, absolutely key. I also talk to them about managing risk factors for both diabetes and cardiovascular disease. There are guidelines that have been put forth by the ADA, ACE and the endocrine society for multiple risk factor intervention to prevent cardiovascular disease in people with prediabetes by lowering blood pressure and cholesterol, as well as glucose and they have largely gone ignored. That’s putting those patients at risk for things beyond diabetes. So yes, I talk to my patients about what they eat and how physically active there are, but I but I also educate them on where they might be going and what we can do to prevent all those things.

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