What is prediabetes?
Prediabetes is a state of impaired glucose metabolism in which blood sugar levels are higher than normal but not high enough to be classified as type 2 diabetes. Many clients will already have insulin resistance when prediabetes is diagnosed.
Prediabetes indicates an increased risk of developing type 2 diabetes, heart disease, and stroke.
Lab values that diagnose prediabetes
Note: You should know these by heart to recognize the red flags!
Prediabetes is diagnosed based on the following blood glucose levels:
- Fasting blood sugar: 100–125 mg/dL
- Oral glucose tolerance test (OGTT): 140–199 mg/dL
- Hemoglobin A1c (HbA1c): 5.7% to 6.4%
Prediabetes lab values
| Normal values | Prediabetes | Diabetes type 2 | |
| Fasting blood sugar | < 100 mg/dL | 100–125 mg/dL | ≥ 126 mg/dL |
| Oral glucose tolerance test | < 140 mg/dL | 140–199 mg/dL | ≥ 200 mg/dL |
| HbA1c | <= 5.6% | 5.7% to 6.4% | >= 6.5% |
Gradual onset and problems with diagnosis
Patients may experience elevated glucose without additional symptoms and may be unaware of their condition. Symptoms may not appear until 50%–80% of the beta cells of the pancreas are damaged and not producing insulin as they should. Statistically, a person can have had type 2 diabetes for 6.5 years before getting diagnosed.
Risk factors for type 2 diabetes
- Family history and non-modifiable risk factors:
- Close relative with diabetes (increases risk 10x)
- Higher age
- High birth weight (possible risk factor)
- Certain ethnicities affected more commonly
- Lower socioeconomic status
- Impaired insulin sensitivity or production of insulin: blood glucose imbalance
- Inappropriate production of glucose by the liver
- Excess adipose tissue and physical inactivity
- Clients who exhibit 3 out of the 5 criteria for metabolic syndrome have a higher risk of developing diabetes (abdominal obesity, elevated glucose, elevated blood pressure, elevated triglycerides, decreased level of HDLs)
Management of prediabetes: make a difference early on
Prediabetes is the time when a change in behavior can have a huge positive impact, so structured interventions are important and can delay or prevent the development of diabetes.
Measures:
- Aim for a 5%–10% weight loss if overweight or obese.
- Adopt a diet with healthy fats, lean proteins, and low-glycemic fruits and breads.
- Limit/avoid intake of processed foods, high sugar beverages, and snacks.
- Focus on portion control and mindful eating.
- Engage in at least 150 minutes of moderate-intensity aerobic activity (e.g., brisk walking) per week.
- Visit a healthcare provider regularly to monitor progress and adjust the treatment plan.
- Screen for other risk factors such as high blood pressure and abnormal cholesterol levels.
- Medications may be prescribed to help lower blood glucose levels.
