What is prediabetes? How did I get it, and what can I do about it?
While it is a somewhat controversial term, prediabetes is a useful way to describe the set of changes doctors see in the blood work of people who are at very high risk of developing type II diabetes. The good news is that prediabetes is not an illness, it is, however, a warning sign that you need to make some changes.
If you catch Type II diabetes in its early stages, before it progresses to damaging your pancreas, the illness is reversible. That’s right, if you change up your eating habits, you can undo some of the damage. If you make the changes while you are in the “prediabetes” zone, you can avoid all the trouble before it starts.
So what is it? Let’s get down to business.
Prediabetes, is a condition characterized by elevated blood sugar levels that are not yet high enough for a diabetes diagnosis.
This condition commonly occurs in individuals who are obese and present with metabolic risk factors such as elevated triglycerides, low HDL cholesterol, and hypertension.
Prediabetes is diagnosed by blood tests for the following screening :
- Impaired fasting plasma glucose (5.6-6.9 mmol/L or 100-125 mg/dL)
- 2-hour glucose tolerance test (75g glucose load, 7.8-11 mmol/L or 140-199 mg/dL)
- HbA1C levels (39-47 mmol/mol or 5.7-6.4%)
First line treatment for prediabetes primarily focuses on making lifestyle changes such as increasing physical activity, improving diet, managing weight, and quitting smoking. Individuals with prediabetes are more at risk of developing severe cardiometabolic complications such as type 2 diabetes, stroke, heart disease, eye problems, nerve damage, and kidney disease. It’s crucial for individuals with prediabetes to regularly monitor their health with healthcare providers to track progress and catch any issues early.
Pharmacologic therapy, such as metformin, may also be considered for high-risk patients to help prevent the onset of type 2 diabetes, often used in conjunction with lifestyle modifications. Other pharmacological options include:
- Alpha-glucosidase inhibitors
- Glucagon-like peptide-1 receptor agonists
- Thiazolidinediones
While genetics play a part, emerging research underscores the profound influence of adverse social determinants such as low income, food insecurity, and not having access to healthcare and health insurance also play a big role in developing prediabetes in adolescents, affecting the health of our most vulnerable population.
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American Diabetes Association Professional Practice Committee. 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes-2024. Diabetes Care. 2024;47(Suppl 1):S20-S42. doi:10.2337/dc24-S002
Brannick B, Dagogo-Jack S. Prediabetes and Cardiovascular Disease: Pathophysiology and Interventions for Prevention and Risk Reduction. Endocrinol Metab Clin North Am. 2018;47(1):33-50. doi:10.1016/j.ecl.2017.10.001
Liu J, Li Y, Zhang D, Yi SS, Liu J. Trends in Prediabetes Among Youths in the US From 1999 Through 2018. JAMA Pediatr. 2022;176(6):608-611. doi:10.1001/jamapediatrics.2022.0077
