Prediabetes – Addressing Diabetes Early

In describing diabetes, there is a gap between showing symptoms indicating the disease is developing and actually becoming diabetic. While it can be clearly stated whether a specific individual has type 1diabetes (T1D) or type 2 diabetes (T2D) there is also a gray area. The gray area is called prediabetes and refers to those who have a high blood glucose level, but the level is not high enough to be called diabetes.

What is Prediabetes?

Prediabetes is a relatively new term used to describe a condition in which individuals register a blood glucose level that is higher than normal, but still lies below the level described as diabetes.[1] Prediabetes can be measured by administering a couple of medical tests. Prediabetes is indicated when an impaired fasting glucose (IFG) blood test reads between 100 mgs/dL and 125 mgs/dL for fasting blood sugar levels and an impaired glucose tolerance blood test reads 140 mgs/dL and 199 mgs/dL for two hour glucose levels as measured by the 75-g oral glucose tolerance test.[2]

A third test is the A1C, which is the acronym for Glycated Hemoglobin Test.  Test results of 5.7 to 6.4 indicate prediabetes.

If a patient is found to have glucose levels that are between the defined results limits of the particular medical test the condition is called prediabetes. This simply means blood glucose levels have risen to the point at which there’s a likelihood diabetes will develop. A diagnosis of prediabetes gives you a warning that it’s time to change your diet and lifestyle to prevent full blown diabetes from developing. Testing blood glucose levels is just one step in understanding the path to diabetes. You should also learn the risk factors that influence a prediabetic condition.

Risk Factors for Prediabetes

When you are at risk for developing diabetes, the risk can seen as an alert to the possibility that you may be a prediabetic. The risks include:[3]

  • Your age – At age 45 the risk of developing type 2 diabetes increases
  • Family history – If your parents, brothers, sisters or children are diabetic, then your risk of becoming a diabetic is higher than normal
  • Race and ethnicity – If your ancestors are from Africa, Asia, Latin America or the Pacific islands, the risk of developing diabetes increases
  • Gestational diabetes (GD) – If you gestational diabetes during your pregnancy, the risk of diabetes is greater, and especially if your blood sugar levels did not return to normal after the birth

Though you can’t prevent risks like race, age or genetics, it’s important to be familiar with these risks so you can be more alert to personal symptoms. The good news is that there are risk factors that you can exert more than a little control over. These consist of:

  • Smoking – Smoking negatively impacts metabolism, so you should quit smoking.
  • Diet – A poor diet can raise your blood sugar levels and lead to obesity due to fat accumulation in the body and cardiovascular disease due to fat in the bloodstream. Fat can interfere with insulin action leading to prediabetes.
  • Exercise – A lack of exercise can increase the risk of developing prediabetes.
  • Weight – Being overweight or obese can lead to prediabetes. You need to manage your weight and track your body mass index (BMI) to determine if you are within the normal range. Also look at your body shape. Are you an apple or a pear? Being an apple is means visceral fat has accumulated around your waist. The apple shape has been associated with a higher risk of developing diseases like cardiovascular disease and type 2 diabetes.  If, instead, you are a pear shape the excess fat is located around the lower abdomen, hips and buttocks. This, too, is a risk factor for developing prediabetes.

The path from prediabetes to being diabetic can be a short one if you don’t address the risks.

Preventing Prediabetes from becoming Diabetes

You can prevent the onset of diabetes or at least delay it if prevention is no longer possible. You can do so by adjusting or modifying various aspects of your life style. In fact, research indicates that lifestyle changes can delay the onset of diabetes by at least 70%.[4] Consider changing or adjusting the following:

  • Diet – change your diet so it is more nutritious. Cut out the processed foods with high chemical, fat and sugar content; reduce the daily caloric intake if you need to lose weight; lower the fat intake; and increase your ingestion of fiber.
  • Exercise – increase your levels of physical activity and do both cardiovascular and strength training exercises. Walk, run, swim, play or go to the gym regularly. It is recommended that you get at least 150 minutes of moderate exercise per week.
  • Stop smoking and quit other bad habits that can harm your health like sitting in front of the television for hours.

In addition to lifestyle changes, your doctor may recommend a drug therapy. While the use of products like metformin have decreased the rate of diabetes by approximately 30%, drugs still are not the most common treatment used to reduce the potential incidences of diabetes. The determination to use drug therapy must be made by a medical professional, of course.

Is Screening for Diabetes the Answer?

Diabetes is a serious problem yet a substantial amount of Americans – estimated at about one third – is as yet not diagnosed. One method for learning whether an individual is prediabetic is through screening. It is generally agreed within the medical community that the screening procedure should be performed on those individuals who are at high risk of becoming a prediabetic and/or diabetic. They include those who:

  • Are over the age 45
  • People at any age if the BMI is 25 kg/m2 or more, including children. Testing should start when they reach age 10 or upon the start of puberty[5]
  • Are overweight or obese
  • Have other potential markers for being at risk such as dyslipidemia or hypertension
  • Have a family history of T2D
  • Have an ethnic background that puts them at higher risk of diabetes
  • Have had gestational diabetes (GD)

Furthermore, any individual who is at high risk of developing prediabetes needs to be screened and tested every 3 years, even if the original tests return as normal.

References

[1] Meltzer, SJ; and Belton, AB (2009). Diabetes in Adults. Toronto: Key Porter Books.

[2] Levin, ME; and Pfeiffer, MA (editors) (2009). The Uncomplicated Guide to Diabetes Complications, 3rd ed. Alexandria, VA: ADA.

[3] Warshaw, HS; and Pape, J (2009). Real-Life Guide To Diabetes. Alexandria, VA: ADA.

[4] Shrot, RJ; Sahebzamani, FM; and Brownlee, Jr., HJ (2004). “Case Study: Screening and Treatment of Pre-Diabetes in Primary Care.” Clinical Diabetes, 22 (2): 98-100.

[5] Fowler, MJ (2011). “Clinical Practice Recommendations.” Clinical Diabetes, 29 (4): 163-166

This article was originally published July 12, 2012 and last revision and update of it was 9/10/2015.