Taking a Preventive Stance

The presence of a chronic inflammatory condition (HIV disease is one of those), weight gain or being overweight, and lack of exercise along with aging predisposes us to impaired glucose tolerance and impaired fasting glucose that is often symptom-free. When these problems happen without a diagnosis of diabetes, it is called prediabetes, which can be a risk factor for a future with the condition. National guidelines suggest that if you are older than 45, especially if your body mass index is over 25, with any other risk factor, then you should be screened every three years. Risk factors include being sedentary, having a family member with diabetes, being in a high-risk ethnic group (descents include African, Latino, Asian, Pacific Islander, and Native American), or having a previous diagnosis of gestational diabetes, hypertension, dyslipidemia, history of vascular disease, or other condition associated with insulin resistance. If you have prediabetes, then it is time to get busy! Modest weight loss and regular exercise are the primary ways to prevent or delay diabetes in these cases. You should also be counseled and treated for any related problems and risk factors, like high cholesterol and smoking. Even though some studies suggest a benefit for oral antidiabetic medications, the evidence was not deemed strong enough in the face of the potential medication side effects to recommend it as routine preventive therapy. As an added precaution, you should be tested for the development of diabetes every year or two. For more information on screening, talk with your doctor about your risk factors and which types of screening might be best for you. Make an appointment with your dietitian to start learning and incorporating good eating habits that will help to prevent or slow the development of diabetes. And don't forget to get a referral to learn about an exercise program that is both realistic and effective to reduce your risk for diabetes. Fields-Gardner is the director of services for the HIV nutrition company Cutting Edge and is a member of the International AIDS Society and the American Dietetic Association's Dietetic Practice Group on HIV and AIDS. She is the author of Living Well With HIV and AIDS: A Guide to Nutrition and a coauthor of HIV Medications: Food Interactions and A Clinician's Guide to Nutrition in HIV and AIDS.