Prediabetes is a condition in which the blood glucose or A1c levels become higher than normal but not high enough to be labeled as diabetes. Blood glucose levels rise when the body cannot process the sugar properly leading to build up of the sugar in the bloodstream.

Read more about causes, symptoms, diagnosis and treatment of diabetes.

What Is Prediabetes?

Prediabetes is a condition in which you have higher blood sugar levels than normal but lower than the values for diabetes. This is a common condition in adults who show no signs or symptoms, and it is a precursor before the diagnosis of diabetes mellitus. People with prediabetes have a 50% chance of developing diabetes within10 years. The normal blood glucose level is between 70 mg/dL to 99 mg/dL. In prediabetic patients the blood glucose level is elevated between 100 mg/dL to 125mg/dL and higher than 125mg/dL in diabetic patients. Patients with prediabetes put you at risk for developing other health problems such as high blood pressure and blood lipid disorders. However, appropriate lifestyle modifications will help in the prevention of developing diabetes.

Symptoms

Many people with prediabetes often do not experience any symptoms until it develops into type 2 diabetes. Therefore, appropriate monitoring in individuals with family history is needed.

Some people with prediabetes may experience: 


  • Increased appetite

  • Unexplained weight loss/weight gain

  • Weakness

  • Sweating

  • Small skin growths

  • Eye changes or blurred vision

  • Slow healing cuts or wounds

  • Darkened skin in armpit or backside of the neck

  • The only sign of prediabetes is elevated blood glucose levels higher than normal levels.

Causes And Risk Factors

Causes


  • Lifestyle factors: food, exercise, stress, and sleep play an important role in developing prediabetes. Healthy choices play an important role in controlling weight gain with an appropriate diet.

  • Family history and genetics: People with a known family history are more prone to develop prediabetes. Blood glucose screening should be done to keep a check. 

  • Obesity: Obesity is an underlying cause of insulin resistance. Even though prediabetes is the result of being overweight, many individuals with obesity may never develop prediabetes. 

  • Insulin-resistance: Insulin is a hormone that helps the body cells to use glucose from the blood. When the insulin does not work properly, there is an accumulation of glucose in the blood, which causes high blood glucose levels that result in prediabetes or diabetes. 


Risk Factors

The most common risk factors that influence prediabetes are age over 45 years, overweight, and family history. 

Some other factors are included as:

  • People with African American, Native American, Latin American, or Asian/Pacific Islander background

  • Women with diabetes during pregnancy 

  • Women with Polycystic ovary syndrome

  • High blood pressure or high cholesterol levels

  • Smoking 

  • Certain medications such as steroids, antipsychotics, and medicines for HIV may contribute tof developing prediabetes.

Prevention

Prediabetes is a precursor to type 2 diabetes, and the same strategies are used to prevent both. The longer you have prediabetes, the more health problems you may experience.
Prevention strategies include adopting healthy eating habits and physical activity at least three times a week. It is also important to check the blood glucose levels in overweight individuals and people with family history. Delaying the onset of this disease may contribute to greater risk.

Diagnosis

 According to the American Diabetes Association, the diagnosis of prediabetes can be made by the following tests-

Glycated haemoglobin test: It is also called HbA1 or A1c. This test helps determine the body's average blood sugar levels from the past two to three months. 

​​​​​​

A1C ​

Normal: Less than 5.7%

Prediabetes: 5.7 - 6.4%

Diabetes: Greater than 6.5%

Fasting glucose test (FPG): This test measures the blood glucose levels when you have had nothing eaten (fasting) for eight hours. It is usually done in the morning. 

Fasting Glucose Test

Normal: Less than 100

Prediabetes: ​100 - 125

Diabetes: 126 or higher

Random glucose test: This test helps determine the blood glucose level at any given time. This test can be done in emergencies or to keep track of the blood glucose levels in prediabetic patients. 

Random (Anytime) Glucose Test

Normal: Less than 140

Prediabetes: 140 - 199

Diabetes: Greater than 200

Treatment

Almost 70% of people with prediabetes will go on to be diagnosed with diabetes mellitus. Therefore, prediabetes management can help prevent the development of diabetes mellitus and lower the risk of other health conditions.
The primary treatment of prediabetes is a lifestyle change and promotion of weight loss by maintaining a healthy diet which can help control blood sugar levels and prevent them from getting higher.
Some people who have failed to maintain adequate lifestyle therapy will require medications for the treatment of prediabetes. Medications are prescribed if you are at high risk for diabetes and other health conditions. The most commonly used medications are metformin and acarbose, which will help prevent diabetes mellitus. Other medications such as thiazolidines have been known to prevent the risk of prediabetes. However, diabetes medicines are not as effective as diet and exercise.

Lifestyle/management

The more appropriate way to treat diabetes is through healthy lifestyle changes. Even small changes will help to lower the risk of the development of diabetes mellitus. The lifestyle changes include: 


  • Losing some amount of body weight will help to manage prediabetes. 

  • Regular physical activity for about 30 min a day, five days a week. 

  • Finding ways to reduce or manage stress

  • Quit smoking and alcohol 

  • Manage sleeping disorders

  • Maintain high cholesterol and high blood pressure.

Prognosis And Complications

Prognosis

In most cases, prediabetes develops into diabetes. Although, in some cases, prediabetes never progresses to diabetes but still risks a cardiovascular disorder. Appropriate interventions can delay early onset prediabetes and reduce progression to diabetes and the burden of cardiovascular disease. 

 

Many ways will help you to reverse prediabetes. It is possible by making lifestyle changes, losing weight, increasing physical activity, and following a healthy diet. However, people with family history and genetics will be at a higher risk of developing diabetes mellitus.

Complications

The progression of untreated prediabetes leads to the development of diabetes mellitus. Other health conditions that arise are: 


  • Heart disease

  • Stroke

  • Blindness

  • Hypertension

  • Insulin Resistance

  • Limb loss


Prediabetes conditions can also lead to serious complications such as macrovascular disease or kidney diseases if untreated. 

References


  1. Prediabetes. Cleveland Clinic Abu Dhabi. Available at: https://www.clevelandclinicabudhabi.ae/en/health-hub/health-library/pages/pre-diabetes.aspx. Accessed on May 13, 2021.

  2. Prediabetes. Stat Pearls. Available at: https://www.ncbi.nlm.nih.gov/books/NBK459332/. Accessed on May 13, 2021.

  3.  Prediabetes. Cleveland Clinic. Available at: https://my.clevelandclinic.org/health/diseases/21498-prediabetes. Accessed on May 13, 2021.

  4. Prediabetes. Diatribe Learn. Available at: https://diatribe.org/prediabetes. Accessed on May 13, 2021.

  5. Prediabetes. Familydoctor. Available at: https://familydoctor.org/condition/prediabetes/. Accessed on May 13, 2021.

  6. Prevention of diabetes mellitus. Diabetes. Available at: https://www.diabetes.co.uk/diabetes-prevention/index.html. Accessed on May 13, 2021.

  7. Prediabetes and diabetes prevention program. John Hopkins Medicine. Available at: https://www.hopkinsmedicine.org/gim/clinical/lifestyle-weight/prediabetes.html. Accessed on May 13, 2021.

  8. Understanding prediabetes. Cleveland Clinic Abu Dhabi. Available at: https://www.clevelandclinicabudhabi.ae/en/health-hub/health-library/pages/understanding-prediabetes.aspx. Accessed on May 13, 2021.

  9. Tuso P. Prediabetes and lifestyle modification: time to prevent a preventable disease. Perm J. 2014 Summer;18(3):88-93. 

  10. Echouffo-Tcheugui, J.B., et al. Lifetime prevalence and prognosis of prediabetes without progression to diabetes. Diabetes Care  2018 Jul;41 (7):e117-e118.

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