Recently, a friend wrote saying she was "mildly diabetic". I wrote back straight away saying: "There's nothing like being 'mildly diabetic'; you're probably prediabetic..."
Anyway, that set me off on a hunt to find a precise definition of "prediabetes". I got the most reasonable answer from Michael Dansinger, MD at WebMD. This is what he has to say:
Many folks come to the diabetes community upon being diagnosed with "prediabetes". These people are usually concerned about progressing to type 2 diabetes and want to know how to delay or prevent such progression. The diagnosis of prediabetes also typically serves as a "wake-up call" to make healthier lifestyle choices.
Interestingly, the term "prediabetes" was recently discredited by the concensus panel of diabetes experts. The experts encouraged replacing "prediabetes" with the concept of "increased risk of diabetes" which is reflected by a continuum of risk ranging from A1c levels of around 5.8 to 6.5. The experts argued that not everyone in this range progresses to diabetes and it is more accurate to see it as a risk spectrum rather than as a category unto itself.
I personally favor the old system of calling it "prediabetes" rather than "increased diabetes risk". I just like the name better. It used to be called "borderline diabetes", but that name seems so outdated to me. In any case, I urge people to see this as a strong warning that diabetes is probably coming, and lifestyle changes are the main way to slow or stop the progression.
I, too, think "prediabetes" is a much more forceful term than "increased risk of diabetes" - the former rings alarm bells, as it should, while the latter seems like a problem that can be taken care of later after more pressing issues like planning a vacation or buying a new computer are taken care of. Bad idea.
Remember, prediabetes (technically "impaired glucose tolerance") is a health condition with no symptoms. It is almost always present before a person develops the more serious type 2 diabetes. Million of people over age 20 have prediabetes with blood sugar levels that are higher than normal, but are not high enough to be classified as diabetes.
More and more, doctors are recognizing the importance of diagnosing prediabetes as treatment of the condition may prevent more serious health problems. For example, early diagnosis and treatment of prediabetes may prevent type 2 diabetes as well as associated complications such as heart and blood vessel disease and eye and kidney disease. Doctors now know that the health complications associated with type 2 diabetes often occur before the medical diagnosis of diabetes is made.
Who's at Risk for Developing Type 2 Diabetes?
Those at risk for type 2 diabetes include:
- People with a family history of type 2 diabetes.
- Women who had gestational diabetes or have had a baby weighing more than 9 pounds.
- Women who have polycystic ovary syndrome (PCOS).
- African Americans, Native Americans, Latinos, and Pacific Islanders, minority groups that are disproportionately affected by diabetes.
- People who are overweight or obese, especially around the abdomen (belly fat).
- People with high cholesterol, high triglycerides, low good 'HDL' cholesterol, and a high bad 'LDL' cholesterol.
- People who are inactive.
- Older people. As people age they are less able to process sugar appropriately and therefore have a greater risk of developing type 2 diabetes.
What Are the Symptoms of Prediabetes?
Although most people with prediabetes have no symptoms at all, symptoms of diabetes may include unusual thirst, a frequent need to urinate, blurred vision, or extreme fatigue.
A medical lab test may show some signs that suggest prediabetes may be present.
Who Should Be Tested for Prediabetes?
You should be tested for prediabetes if:
- You're over 45 years of age.
- You have any risk factors for diabetes.
- You're overweight with a BMI (body mass index) over 25.
- You belong to a high risk ethnic group.
- You were known to previously have an abnormal glucose tolerance test (see below) or have an impaired fasting glucose level (see below).
- You have a history of gestational diabetes or delivering a baby that weighed more than 9 pounds.
- You have clusters of problems seen in the metabolic syndrome. These problems include high cholesterol and triglycerides, high LDL cholesterol and low HDL cholesterol, central obesity, hypertension, and insulin resistance.
- You have polycystic ovary syndrome.
How Is Prediabetes Diagnosed?
To determine if you have prediabetes, your doctor can perform two different blood tests – the fasting plasma glucose (FPG) test and the oral glucose tolerance test (OGTT).
During the FPG blood test your blood sugar level is measured after an 8 hour fast. This laboratory health screening can determine if your body metabolizes glucose correctly. If your blood sugar level is abnormal after the fasting plasma glucose (FPG) test, you could have what's called "impaired fasting glucose," which suggests prediabetes.
Understanding the FPG Test Results
| Condition | FPG |
| Normal | Less than 100 mg/dL (milligrams per deciliter) |
| Prediabetes | 100 mg/dL - 125 mg/dL |
| Diabetes | Greater than 126 mg/dL on two or more tests |
The other laboratory health screening test your doctor can perform is the oral glucose tolerance test (OGTT). During this test, your blood sugar is measured after a fast and then again 2 hours after drinking a beverage containing a large amount of glucose. Two hours after the glucose beverage, if your glucose is higher than normal, you have what's called "impaired glucose tolerance," which suggests prediabetes.
Understanding the OGTT Test Results
| Condition | OGTT |
| Normal | Less than 140 mg/dL |
| Prediabetes | 140 mg/dL to 199 mg/dL |
| Diabetes | Greater than 200 mg/dL |
Why Is It Important to Recognize and Treat Prediabetes?
By identifying the signs of prediabetes before diabetes occurs, you can prevent type 2 diabetes altogether and lower your risk of complications associated with this condition, such as heart disease.
A large 3-year medical study in patients at risk of developing type 2 diabetes found that lifestyle changes with exercise and mild weight loss, and treatment with medications that work to sensitize a person to the actions of insulin, can decrease the chance that a person with prediabetes will get type 2 diabetes by up to 60%.
Changing a person's lifestyle habits with increased physical activities and mild weight loss was more effective than medications at reducing the risk of developing type 2 diabetes. For some people with prediabetes, intervening early can actually return elevated blood sugar levels to the normal, healthy range.
What's the Treatment for Prediabetes?
To successfully treat prediabetes:
- Eat a heart healthy diet and lose weight. A 5% to 10% weight loss can make a huge difference.
- Exercise. Try to exercise 30 minutes a day, 5 days a week. The activity can be split into several short periods: 3 sessions of 10 minutes. Select an activity that you enjoy such as walking. In the study mentioned above, the total amount of exercise per week was 150 minutes.
- Stop smoking.
- Treat high blood pressure and high cholesterol.
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