Pre-diabetes is the medical term for a serious health condition describing people whose blood sugar levels do not meet the established criteria for Type 2 diabetes but are too high to be considered normal. Pre-diabetes is the stage before full-fledged diabetes develops.
Statistics reveal that approximately 88 million American adults – more than 1 in 3 -- live in this pre-diabetic stage. In most cases, a pre-diabetic person will develop diabetes, In order to prevent this progression timely diagnosis is key. Additionally, the patient must be counseled on important lifestyle changes. These might include weight-loss strategies, changes in diet and eating patterns, and an increase in physical activity.
The exact cause of pre-diabetes is unknown, but what is clear is that people with pre-diabetes don't process sugar (glucose) properly anymore. As a result, sugar builds up in the blood instead of doing its normal job of giving energy to the cells that make up muscles and other tissues.
Many people with pre-diabetes have no symptoms, so it often goes undetected until other serious health problems show up. That’s why it’s important to talk to your doctor about getting your blood sugar tested if you have any of the risk factors for pre-diabetes. These are the same factors that increase the odds of getting Type 2 diabetes and include:
- Weight. Being overweight is a primary risk factor for pre-diabetes. The more fatty tissue you have — especially inside and between the muscle and skin around your abdomen — the more resistant your cells become to insulin.
- Waist size. A large waist size can indicate insulin resistance. The risk of insulin resistance goes up for men with waists larger than 40 inches and for women with waists larger than 35 inches.
- Diet. Eating red meat and processed meat, and drinking sugar-sweetened beverages, is associated with a higher risk of pre-diabetes. A diet high in fruits, vegetables, nuts, whole grains and olive oil is associated with a lower risk of pre-diabetes.
- Inactivity. The less active you are, the greater your risk of pre-diabetes. Physical activity helps you control your weight, uses up sugar for energy and makes the body use insulin more effectively.
- Age. Although diabetes can develop at any age, the risk of pre-diabetes increases after age 45.
- Family history. Your risk of pre-diabetes increases if you have a parent or sibling with Type 2 diabetes.
- Race or ethnicity. Although it's unclear why, certain people — including Black, Hispanic, American Indian and Asian American people — are more likely to develop pre-diabetes.
- Gestational diabetes. If you had diabetes while pregnant (gestational diabetes), you and your child are at higher risk of developing pre-diabetes. If you've had gestational diabetes, your doctor will likely check your blood sugar levels at least once every three years.
- Polycystic ovary syndrome. Women with this common condition — characterized by irregular menstrual periods, excess hair growth and obesity — have a higher risk of pre-diabetes.
- Sleep. People with obstructive sleep apnea — a condition that disrupts sleep repeatedly — have an increased risk of insulin resistance.
- Tobacco smoke. Smoking may increase insulin resistance. Smokers also seem to carry more weight around the middle.
Other conditions associated with pre-diabetes include:
- High blood pressure
- Low levels of high-density lipoprotein (HDL) cholesterol, the "good" cholesterol
- High levels of triglycerides — a type of fat in your blood
When these conditions occur with obesity, they are associated with insulin resistance.
The combination of three or more of these conditions is often called metabolic syndrome.
The American Diabetes Association recommends that adults and children 10 years and older should be tested if they’re overweight or obese and have:
- A family member (mother, father, brother, sister) with Type 2 diabetes
- A mother who had gestational diabetes while pregnant with the child
- Native American, African American, Hispanic, Asian American, or Pacific Islander heritage
- Signs of insulin resistance or conditions linked to it, such as a low birth weight, high blood pressure, or polycystic ovary syndrome
If a patient at high risk for pre-diabetes has normal test results, the American Diabetes Association advises testing them again at least every 3 years.
The tests used to diagnose pre-diabetes are the same ones used to test for diabetes.
Fasting plasma glucose test. You won’t eat for 8 hours (typically overnight), and then a technician will take your blood to test the sugar levels. This is the standard test that most people have with routine blood work. The results are:
- Normal if your blood sugar is less than 100 milligrams per deciliter (mg/dL)
- Pre-diabetes if your blood sugar is 100 to 125 mg/dL
- Diabetes if your blood sugar is 126 mg/dL or higher
Oral glucose tolerance test. You need to fast overnight (at least 8 hours). First, they will draw a fasting blood sample. Then, you'll drink a sugary liquid with a specific amount of glucose in it. Two hours after that, a technician will take another blood sample. The results are:
- Normal if your blood sugar is less than 140 mg/dL after the second test
- Pre-diabetes if your blood sugar is 140 to 199 mg/dL after the second test
- Diabetes if your blood sugar is 200 mg/dL or higher after the second test
Hemoglobin A1c test. This blood test shows your average blood sugar levels for the past 2 to 3 months. Doctors give it to people who have diabetes to see if their blood sugar levels are under control. They can also use it to diagnose pre-diabetes or diabetes. The results are:
- Normal if it’s 5.6% or less
- Pre-diabetes if it’s 5.7 to 6.4%
- Diabetes if it’s 6.5% or above
Think of pre-diabetes as a fork in the road: Ignore it, and your risk for Type 2 diabetes goes up. Without intervention, it's likely to become Type 2 diabetes within 5 to 10 years. However, progression from pre-diabetes to Type 2 diabetes isn't inevitable. With lifestyle changes, weight loss, and medications, it's possible to bring a pre-diabetic blood sugar level back to normal.
If you discover that you do have pre-diabetes, remember that it doesn’t mean you’ll develop Type 2, particularly if you follow a treatment plan and make changes to your lifestyle through food choices and physical activity. Even small changes can have a huge impact on delaying or preventing diabetes all together. A modest weight loss of 5-7% of your body weight (just 10 to 14 pounds for a 200-pound person) and regular physical activity for at least 150 minutes a week (that’s just 30 minutes a day, five days a week) can significantly lower your chances of progressing to full diabetes.
Work with a health care professional to make a plan that works for your lifestyle or look for a Centers for Disease Control and Prevention (CDC) recognized lifestyle change program, guided by a lifestyle coach trained to use a CDC-approved curriculum, where you will meet other people who are working to prevent diabetes.
There’s no official diet for pre-diabetes, but these four easy swaps can help lower your chances of getting Type 2 diabetes:
- Choose whole grains and whole-grain products over processed carbs like white bread, potatoes, and breakfast cereals.
- Drink coffee, water, and tea instead of sugary drinks.
- Choose good fats like those in vegetable oil, nuts, and seeds over those in margarine, baked goods, and fried foods.
- Trade red meat and processed meats for nuts, whole grains, poultry, and fish.
The most serious consequence of pre-diabetes is progression to Type 2 diabetes.