What is Prediabetes?
Prediabetes is when blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes. Prediabetes means a person is at increased risk for developing type 2 diabetes, as well as for heart disease and stroke. Many people with prediabetes develop type 2 diabetes within 10 years.
However, modest weight loss and moderate physical activity can help people with prediabetes delay or prevent type 2 diabetes.
Current Facts About Prediabetes
Pre-diabetes is a condition that raises the risk of developing type 2 diabetes, heart disease, stroke, and eye disease.
People with pre-diabetes have impaired fasting glucose (IFG), impaired glucose tolerance (IGT), or both—conditions where blood glucose levels are higher than normal but not high enough to be classified as diabetes.
People with pre-diabetes are 5-15 times more likely to develop type 2 diabetes than are people with normal glucose values.
Progression to diabetes among those with pre-diabetes is not inevitable. Studies show that people with pre-diabetes who lose at least 7% of their body weight and engage in moderate physical activity at least 150 minutes per week can prevent or delay diabetes and even return their blood glucose levels to normal.
Clinical research shows intensive lifestyle interventions are the most effective way to prevent or delay type 2 diabetes.
It is thought that approximately one of every three persons born in 2000 will develop diabetes in his or her lifetime. The lifetime risk of developing diabetes is even greater for ethnic minorities: two of every five African Americans and Hispanics, and one of two Hispanic females, will develop the disease.
How are diabetes and prediabetes diagnosed?
Blood tests are used to diagnosis diabetes and prediabetes because early in the disease type 2 diabetes may have no symptoms. All diabetes blood tests involve drawing blood at a health care provider’s office or commercial facility and sending the sample to a lab for analysis. Lab analysis of blood is needed to ensure test results are accurate. Glucose measuring devices used in a health care provider’s office, such as finger-stick devices, are not accurate enough for diagnosis but may be used as a quick indicator of high blood glucose.
Testing enables health care providers to find and treat diabetes before complications occur and to find and treat prediabetes, which can delay or prevent type 2 diabetes from developing.
Any one of the following tests can be used for diagnosis:
an A1C test, also called the hemoglobin A1c, HbA1c, or glycohemoglobin test
a fasting plasma glucose (FPG) test
an oral glucose tolerance test (OGTT)
Another blood test, the random plasma glucose (RPG) test, is sometimes used to diagnose diabetes during a regular health checkup. If the RPG measures 200 micrograms per deciliter or above, and the individual also shows symptoms of diabetes, then a health care provider may diagnose diabetes.
Symptoms of diabetes include
unexplained weight loss
Other symptoms can include fatigue, blurred vision, increased hunger, and sores that do not heal.
The A1C test is used to detect type 2 diabetes and prediabetes but is not recommended for diagnosis of type 1 diabetes or gestational diabetes. The A1C test is a blood test that reflects the average of a person’s blood glucose levels over the past 3 months and does not show daily fluctuations. The A1C test is more convenient for patients than the traditional glucose tests because it does not require fasting and can be performed at any time of the day.
The A1C test result is reported as a percentage. The higher the percentage, the higher a person’s blood glucose levels have been. A normal A1C level is below 5.7 percent.
An A1C of 5.7 to 6.4 percent indicates prediabetes. People diagnosed with prediabetes may be retested in 1 year. People with an A1C below 5.7 percent maystill be at risk for diabetes, depending on the presence of other characteristics that put them at risk, also known as risk factors. People with an A1C above 6.0 percent should be considered at very high risk of developing diabetes. A level of 6.5 percent or above means a person has diabetes.
Laboratory analysis. When the A1C test is used for diagnosis, the blood sample must be sent to a laboratory using a method that is certified to ensure the results are standardized. Blood samples analyzed in a health care provider’s office, known as point-of-care tests, are not standardized for diagnosing diabetes.
Abnormal results. The A1C test can be unreliable for diagnosing or monitoring diabetes in people with certain conditions known to interfere with the results. Interference should be suspected when A1C results seem very different from the results of a blood glucose test. People of African, Mediterranean, or Southeast Asian descent or people with family members with sickle cell anemia or a thalassemia are particularly at risk of interference.
Changes in Diagnostic Testing
In the past, the A1C test was used to monitor blood glucose levels but not for diagnosis. The A1C test has now been standardized, and in 2009, an international expert committee recommended it be used for diagnosis of type 2 diabetes and prediabetes.
Fasting Plasma Glucose Test
The FPG test is used to detect diabetes and prediabetes. The FPG test has been the most common test used for diagnosing diabetes because it is more convenient than the OGTT(oral glucose tolerance test) and less expensive. The FPG test measures blood glucose in a person who has fasted for at least 8 hours and is most reliable when given in the morning.
People with a fasting glucose level of 100 to 125 mg/dL have impaired fasting glucose (IFG), or prediabetes. A level of 126 mg/dL or above, confirmed by repeating the test on another day, means a person has diabetes.
Oral Glucose Tolerance Test
The OGTT can be used to diagnose diabetes, prediabetes, and gestational diabetes. Research has shown that the OGTT is more sensitive than the FPG test, but it is less convenient to administer. When used to test for diabetes or prediabetes, the OGTT measures blood glucose after a person fasts for at least 8 hours and 2 hours after the person drinks a liquid containing 75 grams of glucose dissolved in water.
If the 2-hour blood glucose level is between 140 and 199 mg/dL, the person has a type of prediabetes called impaired glucose tolerance (IGT). If confirmed by a second test, a 2-hour glucose level of 200 mg/dL or above means a person has diabetes.
Are diabetes blood test results always accurate?
All laboratory test results can vary from day to day and from test to test. Results can vary
within the person being tested. A person’s blood glucose levels normally move up and down depending on meals, exercise, sickness, and stress.
between different tests. Each test measures blood glucose levels in a different way.
within the same test. Even when the same blood sample is repeatedly measured in the same laboratory, the results may vary due to small changes in temperature, equipment, or sample handling.
Although all these tests can be used to indicate diabetes, in some people one test will indicate a diagnosis of diabetes when another test does not. People with differing test results may be in an early stage of the disease, where blood glucose levels have not risen high enough to show on every test.
Health care providers take all these variations into account when considering test results and repeat laboratory tests for confirmation. Diabetes develops over time, so even with variations in test results, health care providers can tell when overall blood glucose levels are becoming too high.
What are the Risk Factors For Prediabetes?
Among those who should be screened for pre-diabetes include overweight adults age 45 and older and those under age 45 who are overweight and who have one or more of the following risk factors:
are habitually physically inactive
have previously been identified as having IFG (impaired fasting glucose) or IGT (impaired glucose tolerance)
have a family history of diabetes
are members of certain ethnic groups (including Asian American, African-American, Hispanic American, and Native American)
have had gestational diabetes or have given birth to a child weighing more than 9 pounds
have elevated blood pressure
have an HDL cholesterol level (the “good” cholesterol) of 35 mg/dl or lower and/or triglyceride level of 250 mg/dl or higher
have polycystic ovary syndrome
have a history of vascular disease
Are all people with pre-diabetes overweight?
Although weight plays an important role in who might develop pre-diabetes, not all people with pre-diabetes are overweight. Even if you are thin you could still develop pre-diabetes.
If your family members have a history of type 2 diabetes, polycystic ovarian syndrome, or Hashimoto’s thyroiditis you may be at risk for pre-diabetes.
Institutes of Health recommend that all people age 45 and older – regardless of their weight and family history get screened for pre-diabetes.
If you have pre-diabetes , what should you do?
The number one line of defense against pre-diabetes is to make changes in your lifestyle. Although there is a strong genetic component tied to the risk of developing pre-diabetes and type 2 diabetes, studies also show a strong correlation between obesity, stress, and physical fitness.
There are people who are thin and active that develop pre-diabetes, but the majority of those at risk are overweight. Losing excess weight is helpful and reducing or eliminating processed carbohydrates and unhealthy fats from your diet is a must if you want to tackle pre-diabetes. If you are inactive, regular exercise can increase your sensitivity to your body’s own insulin and can help reverse pre-diabetes.
The important thing to remember is that medications alone are not enough to address pre-diabetes. Even if your doctor does prescribe a medication to help you in your battle against diabetes, it is very important that you also follow any special dietary guidelines, exercise program, or other lifestyle changing recommendations your doctor prescribes.
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