July 2019 ExtraCare Newsletter

July 2019 ExtraCare Newsletter

July 2019
ExtraCare Newsletter

Ahh, summer is finally here…. long sunny days, barbecues by the pool and picnics at the beach. To remind you why it’s so important to stock that picnic basket with healthy food, I chose to discuss the topic of prediabetes and I provide proof to you skeptics that it’s ok for us to analyze your blood even if you’re not fasting.

I also want you all to know that I will be out of the office on my annual Catalina Island adventure from July 27th-August 4th. During that time I will have spotty cell reception and little access to email. My NP Vicky will be available in the office to see patients and manage prescription refill requests. Also, Dr. Danson will be available as well for emergencies. Please call the office or email Marisela and Jeneva during my absence, and they will help guide you to the appropriate care.


Prediabetes is defined as an elevated average blood sugar above normal, but not high enough to be considered diabetes. Generally, a HBA1C below 5.7% is considered normal, HBA1C 5.7%-6.4% is considered prediabetes and HBA1C 6.5% or above is considered diabetes.

In 2017, 352 (7.3%) million adults were living with prediabetes worldwide, and this number is expected to increase to 587 million (8.3%) by 2045. Prediabetes is a high‐risk state for diabetes; about 5–10% of prediabetes may convert to diabetes annually. According to American Diabetes Association expert panel, 70% of individuals with prediabetes may eventually develop diabetes.

A study published recently in the Journal of Internal Medicine was designed to predict the natural history of prediabetes in older adults.

This was a longitudinal study using a Swedish data base which included patients over the age of 60 and followed them for 12 years.

They found that the overall reversion rate from prediabetes to normoglycemia was 3.4/100 person‐years (about 22%), progression rate to diabetes was 2.0/100 person‐years (13%), and mortality rate was 13.0/100 person‐years (23%). Lower systolic blood pressure, no heart diseases and weight loss were associated with reversion to normoglycemia, and obesity anticipated the progression from prediabetes to diabetes. Physical activity also reduced mortality rate related to prediabetes.

Prediabetes is such a common finding among my patients. I share this study with you to show you that by reducing your weight, controlling your blood pressure and exercising you can lower your risk of progression to diabetes and reduce your risk of death.

To fast or not to fast?

That is the question…

Many of my patients have put off or avoided all together getting their blood drawn because of the difficulty with fasting. Well to all of you, here’s great news. You don’t have to be fasting when you get your blood drawn!

Here’s proof….

An interesting analysis was published recently in JAMA Internal Medicine.

The authors performed a secondary analysis of the ASCOT-LLA trial data, originally published in 2003. That original trial enrolled over 10,000 participants, comparing atorvastatin 10mg vs placebo in the prevention of cardiovascular events. It was stopped early because of the significant improvement in outcomes among the statin group.

This secondary study looked at data from over 8,000 of these participants. They compared the fasting and non-fasting cholesterol panels obtained during initial enrollment and used those data to predict primary endpoints of fatal or non-fatal myocardial infarctions (heart attacks). They found that triglyceride levels were slightly higher in the non-fasting group but overall cholesterol, HDL (good cholesterol) and LDL (bad cholesterol) levels were similar. In addition, when using fasting and non- fasting lipid levels to calculate ten year cardiac risk, both were equally reliable.  

Checking non fasting lipid panels was recently endorsed by the American College of Cardiology and the American Heart Association.

I routinely calculate cardiovascular risk using lipid levels. I was excited when I read this study because it validated my belief and practice that it is NOT necessary to be fasting when obtaining lipid levels.

So go ahead, drink that morning cup of coffee and eat that slice of avocado toast before coming in for your blood draw. It’s OK, I promise 😉
September 6, 2019 Uncategorized
Jeneva Escalera
About Jeneva Escalera