WHAT DOES IT MEAN TO HAVE PREDIABETES?

Prediabetes is a condition where your blood sugar levels are higher than normal, but not high enough to be diagnosed with type 2 diabetes. It is a sign that someone’s body is not metabolizing glucose normally — which will develop into type 2 diabetes if left untreated.

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The condition is also known as:

• impaired fasting glucose (IFG)
• impaired glucose tolerance (IGT)
• non-diabetic hyperglycemia
• impaired glucose regulation (IGR)
• high-risk state of developing diabetes

An estimated 88 million adults in the U.S. have diabetes. However, the prevalence of prediabetes is increasing worldwide, and over 470 million people are expected to have prediabetes by 2030.

Despite its prevalence, over 80 percent of people with prediabetes don’t know that they have the condition. The condition can also increase the risk of heart disease and stroke.

However, prediabetes is like a window to prevent diabetes. The condition can typically be reversed with lifestyle changes — more of which you can learn below.

WHAT ARE THE SYMPTOMS OF PREDIABETES?

Prediabetes has no clear symptoms, and the condition can take years to develop.

Some people with prediabetes might experience acanthosis nigricans, a skin condition that causes dark, velvety patches in skin folds. This discoloration typically occurs around:

• the back of your neck
• your groin
• elbows
• armpits

The condition is most common in Native Americans, followed by African American, Hispanics, and Caucasians.

As the condition progressively develops into type 2 diabetes, a person may experience:

• increased thirst
• going to the toilet more often (especially at night)
• increased hunger
• fatigue
• issues with vision (diabetes-related retinopathy)
• cuts and wounds are slow to heal

In case you have been diagnosed with prediabetes or are experiencing the symptoms above, you should consult a doctor to confirm if you have the condition.

CAUSES OF PREDIABETES

Researchers don’t clearly understand the cause of prediabetes but have found that the condition is often associated with a poor diet, physical inactivity, and obesity.

Insulin is a hormone released by your pancreas that is released to help glucose enter the cells of your body to be used as an energy source.

However, some people develop a condition known as insulin sensitivity — where your body does not respond well to insulin. Prediabetes is an indication that your body is not using insulin as effectively.

Fasting blood sugar tests are often accurate in determining if you have diabetes. Here are the blood sugar level ranges and what they mean:

• 99mg/dL or lower is considered normal
• 69 mg/dL or lower is considered hypoglycemia (low blood sugar)
• blood sugar levels between 100 and 125 mg/dL indicate prediabetes
• 126 mg/dL or higher indicates you have diabetes

You are diagnosed with prediabetes if your blood sugars are between 100 to 125 mg/dL. However, the condition is often reversible and can be prevented from developing into type-2 diabetes with the right measures.

HOW PREDIABETES DEVELOPS INTO TYPE 2 DIABETES

An estimated 5 to 10 percent of people with prediabetes become diabetic every year. The condition typically starts as your cells become insulin resistant.

In response, your pancreas produces more insulin to get your blood sugar levels down. Over time, this can overwork your pancreas, and it eventually can’t produce adequate amounts of insulin.

Without treatment, the condition causes chronically high blood sugar levels, eventually developing into type 2 diabetes.

RISK FACTORS

One in three adults in the U.S. have prediabetes, and the condition can occur in almost anyone. However, certain factors can significantly increase your risk of developing the condition.

• Age. Prediabetes is more common in individuals aged 45 years and above.
• Sex. According to the CDC, 41 percent of male adults have prediabetes compared to 32 percent of women. Research also suggests that the association between risk factors and prediabetes is stronger in men.
• Obesity. Obesity is considered the primary risk factor for developing prediabetes. Excess visceral fat has been independently associated with an increased incidence of prediabetes.
• Diet. Increased consumption of refined grains, processed meats, and sugar-sweetened beverages (including fruit juices) can increase your risk of developing prediabetes.
• Smoking. Nicotine in cigarettes can lead to the development of insulin resistance, which can significantly increase the risk of prediabetes.
• Waist size. If you have a large waist measurement despite having a healthy BMI, you still might be at risk of diabetes. A waist size of less than 37 inches for most men and 31.5 inches for women is considered healthy.
• Race and ethnicity. According to the CDC, prediabetes and diabetes are more common in American Indian, Asian American, Native Alaskan, or Hispanic communities.
• Family history. Having a family history of type 2 diabetes or an immediate relative with the same can increase your risk of developing prediabetes.
• Stress. Studies have found that psychological stress, including symptoms of anxiety, depression, and fatigue can increase the risk of prediabetes and T2D.
• Medical conditions. Certain conditions such as gestational diabetes, high blood pressure, low HDL “good” cholesterol, insomnia, sleep apnea, and PCOS have been linked with a higher risk of developing prediabetes and type 2 diabetes.

Besides genetic predisposition and certain medical conditions, most risk factors of prediabetes can be managed and reversed with lifestyle and behavioral interventions.

HOW IS PREDIABETES DIAGNOSED?

Your healthcare provider checks for prediabetes by conducting a blood test.

The National Institutes of Health (NIH) recommends that if you suspect prediabetes but the initial screening results are normal, you should consider repeating the test is a shorter period of time or confirm the test result with an alternative test option.

Typically, a doctor will use one of the following tests:

FASTING PLASMA GLUCOSE TEST

A fasting plasma glucose test involves not eating or drinking anything expect water for 8 to 12 hours before the test.

Your healthcare provider will then take a blood sample through a finger prick or by needle, which will be tested for blood sugar levels.

Here’s what your fasting plasma glucose test results indicate:

• Normal: 99 mg/dL or lower
• Prediabetes: 100 to 125 mg/dL
• Diabetes: 126 mg/dL or above

If the test results reveal that you are prediabetic, the doctor might ask you to repeat

HAEMOGLOBIN A1C TEST

The hemoglobin A1C test — commonly called the A1C or HbA1c test — measures your average blood sugar levels over the past three months.

Everyone has some sugar attached to their hemoglobin, but people with higher-than-normal blood sugar levels show higher levels of these “attached sugars.”

The A1C test is performed in a doctor’s office or a lab by extracting a blood sample from a finger prick or your arm. The test does not require you to fast.

Here are what your A1C values indicate:

• Normal: Below 5.7 percent
• Prediabetes: Between 5.7 to 6.4 percent
• Diabetes: 5 percent or above

Within the 5.7 to 6.4 percent range, the higher your A1C results, the greater your risk of developing T2D.

If someone has an HbA1c of 6 percent or higher, their relative risk of diabetes increases by 20 times compared to someone with an HbA1c of 5 percent or less.

ORAL GLUCOSE TOLERANCE TEST

The oral glucose tolerance test (OGTT) tests an individual’s insulin sensitivity and insulin resistance.

The patient is instructed to eat a normal carbohydrate diet of at least 150 grams of carbs for at least 3 days prior to the test. The patient is then required to fast 8 hours or overnight before taking the test.

The doctor will first take a sample of blood before the test. The individual will then be asked to drink about 75 grams of glucose, which will be followed by multiple blood sample collections every 30 to 60 minutes for up to 3 hours.

The test evaluates how well your body processes blood sugar,  and helps in identifying insulin resistance.

TREATMENT FOR PREDIABETES

If you have been diagnosed with prediabetes, you should consider yourself as being at a stage where you can prevent the condition from progressing into diabetes.

If left untreated, 37 percent of individuals with prediabetes may have the condition develop into diabetes within 4 years. However, with lifestyle interventions alone, this number decreases to 20 percent.

A study published in 2022 found that 93 percent of adults at an increased risk of type 2 diabetes who began lifestyle interventions within 3 months to 8.3 years of developing prediabetes did not progress to T2D.

Additionally, nearly half of them had returned to normal glucose regulation.

The most common steps in treating prediabetes include:

• regular physical activity to improve insulin sensitivity
• a diet that is rich in fiber, high in protein, and low in processed foods
• limiting alcohol consumption and quitting smoking
• managing stress

Some people who are at a high risk of developing type 2 diabetes may also need to take certain blood sugar-lowering medications. Metformin remains to be one of the most commonly prescribed such drugs.

COMPLICATIONS

If left untreated, up to 70 percent of individuals with prediabetes may eventually develop type 2 diabetes.

Once you have diabetes, you are at an increased risk of several other conditions, such as:

• diabetes-related retinopathy
• neuropathy
• heart attack
• stroke
• foot problems
• skin problems
• urinary tract infections

According to a study, the most prevalent diabetic complications by incidence in patients are:

• Hypertension: 46 percent
• Peripheral sensory neuropathy: 12 percent
• Coronary artery disease: 8 percent
• Retinopathy: 8 percent

In general, the longer you’ve had diabetes, the greater your risk of developing such complications.

Early-stage diabetes can be successfully reversed in some cases with weight loss and other lifestyle interventions.

PREVENTING PREDIABETES

According to the CDC, more than 80 percent of American adults don’t know that they have prediabetes.

Educating yourself about prediabetes and T2D, along with their early signs, diagnosis, and complications is essential for preventing and controlling the conditions.

Lifestyle interventions that promote healthy diets, physical activity, and maintaining a healthy body weight have been highly successful in preventing or delaying diabetes.

A high-calorie intake increases the risk of diabetes by 11 to 26 percent, whereas “modest” physical activity can reduce the risk by 8 to 30 percent.

Most programs that provide steps to prevent or delay prediabetes and T2D suggest:

• maintaining a healthy calorie balance
• eating more fiber-rich fruits such as fruits and vegetables
• limiting intake of processed foods and sugars
• exercising for at least 150 minutes per week, with higher intensity exercise typically yielding better results
• quitting smoking and limiting alcohol
• practicing stress management

To avoid relapse of the disease, it is important to maintain these lifestyle and behavioral changes.

OUTLOOK

Being diagnosed with prediabetes does not mean that you are bound to develop diabetes. The condition is like a window of opportunity for most people — allowing them to prevent one of the most common chronic diseases.

However, managing your blood sugar levels requires strict adherence to certain lifestyle changes, many of which require life-long discipline.