Prediabetes is very common, affecting 1 in 3 American adults.
Getting enough exercise, eating a wholesome diet, and maintaining a healthy weight can reverse symptoms of prediabetes and prevent type 2 diabetes from developing.
Contents of this article:
What is prediabetes?
Being aware of prediabetes can help individuals prevent diabetes type 2.
Insulin is a hormone responsible for transporting sugar from the bloodstream to the cells to use for energy.
When a person has prediabetes, their body cannot use insulin effectively.
Sometimes this results in the cells not getting enough sugar, which leaves too much sugar circulating in the bloodstream.
High blood sugar levels can cause serious health complications, especially damage to the blood vessels, heart, and kidney.
According to the Centers for Disease Control (CDC), around 86 million Americans have prediabetes, but many do not know they have the condition.
Most people who have prediabetes don't experience any symptoms. By the time they do, it's usually a sign that the condition has progressed to type 2 diabetes.
The American Diabetes Association suggests that people should consider blood-screening tests when they are about 45 years old.
However, glucose testing should begin earlier for those with risk factors for diabetes, such as being overweight or having a family history of diabetes.
Several blood sugar tests can confirm a prediabetes diagnosis. Doctors will repeat tests two or three times before making an official diagnosis.
Here are the most common diagnostic tests.
Glycated hemoglobin (A1C) test
This test checks the average levels of sugar in a person's blood over the past 3 months. An A1C blood test score of between 5.7 and 6.4 percent means an individual is likely to have prediabetes.
Some conditions, such as pregnancy, affect blood sugar levels. This may interfere with A1C results.
In addition, results for some people from certain ethnicities, or those with certain blood disorders, such as sickle cell anemia, may show inaccuracies in a1c testing. This can lead to a misdiagnosis or poor management of the disease.
Fasting blood glucose test (FBGT)
The fasting blood glucose test measures sugar levels at one particular point. A result of between 100 and 125 milligrams per deciliter (mg/dL) is considered a sign of prediabetes.
Those undergoing an FBGT cannot eat or drink for at least 8 hours before giving a blood sample. Many schedule the test for early morning, a time when most have already been fasting overnight.
Oral glucose tolerance test (OGTT)
The OGTT also requires 8 hours of fasting. Typically, blood sugar levels will then be checked before and 2 hours after drinking a glucose drink.
Other protocols include testing blood sugar levels every 30 to 60 minutes after consuming the glucose drink.
A 2-hour value between 140 and 199 milligrams per deciliter (mg/dL) is considered impaired glucose tolerance. It is a sign of prediabetes.
The OGTT is often used to help diagnose those who are not good candidates for the A1C test. These people include women suspected of having gestational or pregnancy-related diabetes and those with blood conditions.
Prediabetes testing on children
According to the American Diabetes Association (ADA), the number of children with type 2 diabetes in America is increasing.
The ADA recommend annual diabetes screening for children who are overweight or have a combination of risk factors for prediabetes. Test results for children should be interpreted the same way as those for adults.
Diabetes risk factors for children include:
The number of children in the U.S. with prediabetes is rising.
- Being overweight: Children who are obese or have high levels of belly fat.
- Sex: Type 2 diabetes impacts more girls than boys.
- Age: Most type 2 diabetes diagnoses on children are made by the time they are age 10.
- Family: Children who have family members with type 2 diabetes, or a mother who had gestational diabetes.
- Race or ethnicity: Children of African-American, Native American, and Hispanic descent are more likely to develop type 2 diabetes.
Once prediabetes has been diagnosed, people must continue to get tested regularly. This gives doctors a better understanding of the person's situation and the progression of the condition.
Keeping an eye on blood sugar levels over a period of time also helps to track the impact that any lifestyle changes have made.
People with prediabetes should have blood glucose tests at least once a year. Many doctors will require people to have tests more often depending on their individual risk factors.
Many factors can contribute to the development of prediabetes.
Increasingly a link between genetics, family history, and prediabetes has been identified. However, inactivity and excess belly fat are considered to be the most common and influential causes of prediabetes and type 2 diabetes.
Risk factors for prediabetes and type 2 diabetes include:
- Being overweight or obese: The more fatty tissue that is present, the less sensitive to glucose the cells become.
- Excess fat around the abdominal region: For women, a waist size over 35 inches is linked to a higher prevalence of prediabetes. For men, a waist size over 40 inches is considered a risk.
- Age: Prediabetes can develop in anyone of any age, but the risk of prediabetes is thought to rise after the age of 45 years. This may be due to inactivity, poor diet, and a loss of muscle mass, which typically declines with age.
- Diet: Excess carbohydrate, especially sweetened foods or beverages, can impair insulin sensitivity over time. Diets high in red or processed meats are also linked to the development of prediabetes.
- Sleep patterns: People with obstructive sleep apnea have an increased risk of developing prediabetes.
- Family history: Having an immediate relative with type 2 diabetes significantly increases the risk of developing the condition.
- Stress: During periods of stress the body releases the hormone cortisol into the blood stream, raising blood glucose levels. People who experience long-term stress may have Cushing's syndrome, which can cause diabetes.
- Gestational diabetes: Women who give birth to babies weighing 9 pounds or more may be at a higher risk for prediabetes. Women who develop gestational diabetes during pregnancy, and their children, are at a higher risk of developing the condition.
- Polycystic ovary syndrome (PCOS): Women with PCOS are more susceptible to insulin resistance, which can lead to prediabetes, or diabetes type 2. Women with diabetes type 1 have a higher risk of PCOS.
- Ethnicity: The risk of developing prediabetes tends to be higher for African-Americans, Native Americans, Hispanics, Pacific Islanders, and Asian Americans. The reason remains unclear.
- Metabolic syndrome: When the impact of obesity, high blood pressure, high levels of triglycerides ("bad" fats) and low levels of high-density lipoprotein (HDL or "good" fats) combine, insulin resistance can occur. Metabolic syndrome is defined as the presence of three or more conditions that influence metabolism.
Treatment and alternative therapies
Prediabetes can be reversed through exercise and diet. But according to the CDC, 15 to 30 percent of people with prediabetes will develop type 2 diabetes if they do not make these lifestyle changes.
A healthful diet and exercise can prevent prediabetes from progressing to diabetes type 2.
Not every recommendation works for everyone, but consistently eating a healthful diet, and exercising regularly are the main ways to prevent prediabetes progressing to type 2 diabetes.
Lifestyle changes that can reduce the chances of developing type 2 diabetes include:
- Weight loss: Losing roughly 7 percent of total body weight, particularly reducing belly fat, may reduce the risk of developing type 2 diabetes by 58 percent.
- Moderate, consistent activity: People with diabetes should attempt 30 minutes of moderate exercise five times per week.
- Increasing muscle mass: Muscle burns calories at a higher rate than fat, which can contribute to reaching a healthy weight. This, in turn, helps to stabilize blood glucose levels.
- Increasing flexibility: Stretching is a form of exercise. Being flexible can also help reduce the impact of injuries and improve recovery.
- Reducing stress: Stress causes the release of a hormone called cortisol into the blood stream, which raises blood glucose levels.
- Healthful diet: Diets, which are high in fiber, lean proteins, and complex carbohydrates but low in simple sugars, help keep blood glucose levels stable.
- Keeping a strict meal schedule: Eating smaller meals regularly throughout the day helps prevent spikes and dips in blood glucose levels. Most people need to eat every 3 to 5 hours to best manage blood sugar levels.
- Stopping smoking: Nicotine is a stimulant, which raises blood glucose levels. Smoking can cause insulin resistance and is a risk factor for the development of diabetes.
- Avoiding excess sugars: Foods and drinks with added sugars cause spikes and dips in blood glucose and contribute to being overweight.
- Coffee intake in moderation: Caffeine is a stimulant that increases blood glucose levels. However, some studies have shown that coffee has been linked to increasing insulin sensitivity.
- Getting enough sleep: Being tired or sick can increase stress levels, which can increase blood sugar.
- Monitoring blood glucose: People with prediabetes risk factors or high blood glucose levels may need to monitor their levels at home.
- Taking medications as prescribed: Some people with prediabetes may be prescribed medications such as metformin to manage their symptoms.
Treating conditions that impact blood glucose levels
There are a number of ways to treat conditions that impact a person's blood sugar levels. These include:
- Getting others involved: The more people who know you are trying to make lifestyle changes the better. Telling loved ones about your goals or forming a group with others managing prediabetes is a good way to make and maintain the necessary changes.
- Setting realistic goals and making changes slowly: Focus on what you can do day to day. Setting unrealistic goals means people are less likely to meet them and this may cause them to feel discouraged. The American Diabetes Association offers advice to help people get started.
- Online tests: These exist to assess symptoms. Online tests may be helpful, but if anyone experiences any symptoms of prediabetes, they should see their doctor.
Progression to type 2 diabetes
Signs that prediabetes has progressed to type 2 diabetes include:
- increased or unrelenting thirst
- fatigue or feeling weak
- feeling faint or dizzy
- blurred vision
Anyone who experiences these symptoms should see a doctor.
While there is still little evidence to prove that alternative therapies can treat prediabetes, they may help in the management of the condition.
Aromatherapy and relaxation techniques can reduce stress, one of the risk factors for diabetes type 2.
A range of herbs, vitamins, and minerals may help.
- cassia cinnamon
- aloe vera
- alpha-lipoic acid, which is an antioxidant found in foods, such as spinach, broccoli, and potatoes
- omega-3 fatty acids can help stabilize blood glucose levels
Alternative therapies that can reduce the risk by decreasing stress include relaxation therapy, aromatherapy, massage therapy, and reflexology.
However, alternative therapies should not be used in place of a healthful diet, regular exercise, and medical attention for people who have symptoms.