The process by which blood glucose levels become elevated is the same for prediabetes as it is for type 2 diabetes. Normally, the hormone insulin acts on the cells of your body, moving the glucose in your blood into the cells so that it can be used as energy. In prediabetes the cells are resistant to the effect of insulin and the pancreas, the organ that produces insulin, can’t produce enough to overcome this resistance. As a result, glucose levels build up in the blood. Prediabetes is a condition whose prevalence is on the rise. According to The American Diabetes Association, in 2010 79 million Americans had prediabetes while statistics from 2012 demonstrated that 86 million Americans, roughly 37 percent of the adult U.S. population, were prediabetic.
Risk Factors for Prediabetes
The risk factors for prediabetes mirror those for type 2 diabetes:
- Obesity or Excess Weight
- Sedentary Lifestyle
- Race (African-Americans, Hispanics, Asian-Americans, and American Indians are all at increased risk)
- Older Age (although statistics show the incidence of prediabetes is increasing among children)
- Family History of Type 2 Diabetes
- Personal History of Gestational Diabetes
- High Blood Pressure
- Abnormal Cholesterol Levels (Low high-density lipoprotein or HDL cholesterol and/or high triglyceride levels)
What Are the Symptoms of Prediabetes?
The majority of people with prediabetes have no symptoms and don’t even know that they have the condition until routine blood work reveals an elevated blood glucose level. Some people, however, will experience symptoms characteristic of diabetes such as increased thirst, frequent urination, fatigue, or blurred vision.
How Is Prediabetes Diagnosed?
There are three main tests used to diagnose prediabetes: the glycated hemoglobin or A1C test, the fasting glucose test, and the oral glucose tolerance test. Often these tests are performed if someone has had an elevated blood glucose level on their routine blood work suggesting either prediabetes or diabetes.
Many experts consider the A1C test to be the most helpful as it reflects your average blood glucose level over the past 2 to 3 months. Blood glucose attaches to hemoglobin, the oxygen-carrying component of blood. As the amount of glucose in your blood increases, so does the amount of hemoglobin with glucose attached or glycated hemoglobin. Having an A1C of 5.7 percent to 6.4 percent means you have prediabetes.
Fasting blood glucose test is a measure of your blood glucose level after fasting overnight or for at least 8 hours. A fasting blood glucose level of 100 milligrams per deciliter (mg/dl) to 125 mg/dl means you have prediabetes.
The oral glucose tolerance test allows your healthcare provider to assess how your body responds to glucose by measuring your blood glucose level before and 2 hours after consuming a prescribed drink with a high sugar or glucose load. A blood glucose level of 140mg/dl to 199mg/dl 2 hours after drinking the oral glucose tolerance test drink means you have prediabetes.
How Is Prediabetes Treated?
Treatment for prediabetes involves making lifestyle modifications such as maintaining a healthy weight and exercising. Changing your diet to include plenty of nutrient rich fruits, vegetables, whole grains, and lean proteins and to eliminate high fat, high sugar, and processed foods can help you maintain better blood glucose levels. These dietary changes along with exercise, which is good not only for your heart health but for preventing many other diseases including some cancers, can help you lose weight which is a proven strategy for preventing the development of diabetes.
Some people with prediabetes, particularly those people at high risk of developing diabetes, may be placed on a medication called metforim (Glucophage) which both increases your muscle cells’ sensitivity to insulin and reduces the amount of glucose released by the liver.
The good news is that these treatment strategies can make a difference in preventing your prediabetes from progressing to diabetes. A large multi-center trial of over 3,000 people with prediabetes, called the Diabetes Prevention Program, demonstrated that those study participants who lost weight through diet and exercise significantly reduced their chances of progressing to diabetes. The study participants who were placed on metformin therapy also reduced their risk of diabetes, although to a lesser extent.
Originally published in May 2016 and updated.