Blake Brown tried not to cry when his doctor told him he had pre-diabetes in February, the month he turned 10.
"It scared me," Blake says softly in his Mesquite home, sitting near family pictures that included his father, who also struggled with his weight and died of a heart attack at 44, when Blake was 3.
With pre-diabetes, people have blood glucose levels that are higher than normal, but not high enough to be classified as diabetes. Ten years ago, most doctors would not have alarmed patients with the term, says Dr. Jeffrey A. Astbury, an internist on the medical staff at Baylor Medical Center at Waxahachie who treats pre-diabetes in his private practice.
"In the past, we referred to it as borderline blood sugars or impaired glucose tolerance or impaired fasting glucose," Astbury says. "Now the term pre-diabetes is preferred, because it raises concern and provides a teachable moment."
The new language is part of a push to spur patients to action amid a growing concern about diabetes. In the U.S., nearly 24 million adults have the disease, and 57 million have pre-diabetes, with one of three children and one of two minority children on track to get diabetes, says the American Diabetes Association.
And as many as one-third to one-fifth of U.S. adults could have diabetes by 2050 unless current trends change, according to a study just released by the U.S. Centers for Disease Control and Prevention.
Unlike Type 1 diabetes, an insulin-dependent condition with no known relation to weight or lack of exercise, obesity and inactivity are fueling the rising levels of Type 2 diabetes, in which the insulin the body produces becomes less efficient at moving sugar out of the bloodstream.
The word pre-diabetes scared Blake and his mother, Karen Brown, 50, into reaching out to the Cooper Clinic's Healthy Habits for Kids program. They began working with dietitian Patty Kirk, the clinic's co-director of nutrition.
They hammered out an eating and exercise program that would work with Blake's likes and interests, even taking into account the snacks that he wanted while he was at day care.
Dr. Heidi Shea, an endocrinologist practicing in Dallas and Plano, says this early identification is important, because the best time to help people is before they get diabetes.
"Once you get diabetes, there's no turning back," she says. "It's harder to manage and you've already had cardiovascular disease and damage to the blood vessels, the kidneys and the eyes by the time you get the diagnosis."
Why the change?
Doctors didn't focus on pre-diabetes in the past because as recently as 10 years ago, they didn't fully understand the disease's progressive nature, Shea says.
In Blake's case, his doctor had observed a dark, rough spot on the back of his neck called acanthosis nigricans, a skin condition associated with obesity and high insulin levels in the body.
The doctor also noted that Blake's body mass index was nearly 26, when it should have been much lower. Other clues that doctors now look for are obesity, hypertension, abnormal cholesterol, high triglycerides and a waist circumference greater than 47 inches in men and about 34 inches in women.
Emma Tatum, 71, of Dallas says she shouldn't have been surprised when her doctor told her she had pre-diabetes. When she was 12, her mother, a Type 1 diabetic, died in childbirth at 37. Her father, one of her sisters and three of her brothers died of complications related to diabetes. Her one surviving sister was recently diagnosed with Type 2 diabetes.
Tatum and her husband participate in exercise and cooking classes, and she credits them with easing her blood sugar and blood pressure back to normal.
"It's a fun thing," Tatum says. "We look forward to it. Sometimes one of us doesn't feel like going and the other will do the encouraging."
As for Blake Brown, he has met every goal that he and nutritionist Kirk have set.
He has lost 11 pounds (and grown a half an inch) since he started the program in March. In October, his BMI had dropped below 23. He says he feels good about his new diet and lifestyle.
Blake and his mom enjoy showing off their stationary bicycle and treadmill, their Wii Fit and exercise videos, and the fruits and vegetables in their refrigerator.
Karen Brown, who has hypertension but not diabetes, has lost 72 pounds.
"I am so glad they scared us a little bit because it's helped Blake learn tools for the rest of his life," his mother says.
As for Blake, what made it all worthwhile was finally hearing from his doctor that he no longer has pre-diabetes.
"I feel so glad, so happy."