Prediabetes is a health condition that occurs when blood sugar levels are above normal, but are not high enough for a diagnosis of Type 2 diabetes. When left unchecked, prediabetes increases the risk of developing Type 2 diabetes. This is why it is important to catch prediabetes early so that modifications to diet and lifestyle habits can be implemented as soon as possible to prevent the development of Type 2 diabetes and its associated healthcare costs and complications.1
Risk Factors
Over 84 percent of people with prediabetes do not know they have it, in part because prediabetes often does not cause any clear signs or symptoms.3 The Centers for Disease Control and Prevention (CDC) recommends prediabetes testing for adults who meet any of the following risk factors:
- 45 years of age or older
- Overweight or obese
- Physically inactive
- Member of a high risk race/ethnicity group (African American, Hispanic/Latino American, American Indian, Pacific Islander, Asian American)
- First-degree relative with Type 2 diabetes
- History of cardiovascular disease
- History of gestational diabetes
- History of polycystic ovary syndrome
- Hypertension
- HDL cholesterol level <35mg/dL and/or triglyceride level >250mg/dL3,4
People with prediabetes have a 50-percent greater chance of developing Type 2 diabetes within 5 to 10 years,5 so it is imperative that those at risk get tested. Prediabetes can be tested through a fasting plasma glucose (FPG) test, A1C test, or oral glucose tolerance test (OGTT). FPG of 100 to 125mg/dL, A1C of 5.7 to 6.4 percent, or OGTT of 140 to 199mg/dL indicate prediabetes.5,6
Prevention
Reduce weight and increase physical activity. Luckily, prediabetes is a reversible condition, and people with it who take the right steps can avoid developing Type 2 diabetes altogether. For people with overweight or obesity, losing even a small amount of weight (e.g., 5–7 percent of one’s body weight) and undertaking a moderate, consistent exercise regimen (e.g., brisk walking) at least 150 minutes per week can decrease the chance of developing Type 2 diabetes by as much as 58 percent over three years.3,5,7,8
Break unhealthy lifestyle habits. Other ways to reduce risk of developing Type 2 diabetes include managing stress, getting enough sleep and treating sleep disorders, quitting smoking, reducing alcohol consumption, and
managing high blood pressure and high cholesterol.5
Improve diet. People with prediabetes can also prevent developing Type 2 diabetes by adopting a healthy diet, with the help of a nutritionist or dietitian. People with diabetes should consider consulting with a registered dietitian about implementing medical nutrition therapy or taking part in the CDC-led Diabetes Prevention Program (DPP).3,8 Those trying to lose weight should reduce total dietary fat and calorie intake, and macronutrient distribution should be tailored according to the individual’s current eating patterns, preferences, and metabolic goals.8
Eating nonstarchy vegetables (e.g., peppers, broccoli, leafy greens, mushrooms), whole grains (e.g., quinoa, brown rice, steel-cut oatmeal), fruits, lean protein (e.g., chicken, fish, tofu, eggs, yogurt), and drinking more water are beneficial additions to a healthy diet. Foods and drinks that should be avoided or limited include sugary beverages, alcohol, foods with added sugars, foods with trans fat (e.g., fried food, packaged baked goods, margarine), and processed foods (e.g., packaged snacks, packaged meat, chips, sweets, and fast food).8,9
Mediterranean-style, vegetarian, and plant-based diets, as well as Dietary Approaches to Stop Hypertension (DASH) are associated with a decreased risk of developing Type 2 diabetes.7,8 Diets with higher total fat and lower carbohydrate intake have been shown to improve the concentration of glucose in the blood and certain cardiovascular disease risk factors compared to low-fat diets.8 However, the quality of the fat consumed is key—trans fats should be avoided, while unsaturated fats and omega-3 fatty acids should be prioritized.8,9
SIDE NOTE: Prediabetes may be linked to worse brain health
Researchers from University College London analyzed data from the UK Biobank of 500,000 people aged 58 years on average, and found that people with higher than normal blood sugar levels were 42% more likely to experience cognitive decline over an average of 4 years, and were 54% more likely to develop vascular dementia over an average of 8 years (although absolute rates of both cognitive decline and dementia were low). Source: University College London. Prediabetes may be linked to worse brain health: People with prediabetes, whose blood sugar levels are higher than normal, may have an increased risk of cognitive decline and vascular dementia, according to a new study led by UCL researchers. ScienceDaily site. www.sciencedaily.com/releases/2021/02/210211195335.htm (accessed December 2, 2021).
Bottom Line
Prediabetes is a common condition, and most people with prediabetes do not know they have it. Fortunately, prediabetes is treatable and reversible through lifestyle modifications. With the proper screenings and lifestyle interventions, people with prediabetes can successfully lower blood sugar levels and prevent the onset of Type 2 diabetes.
Sources
1. Centers for Disease Control and Prevention website. What Is diabetes? Reviewed 11 Jun 2020. https://www.cdc.gov/diabetes/basics/diabetes.html. Accessed 18 Oct 2021.
2. Centers for Disease Control and Prevention website. National Diabetes Statistics Report. 2020. https://www.cdc.gov/diabetes/data/statistics-report/index.html. Accessed 18 Oct 2021.
3. Centers for Disease Control and Prevention website. Prediabetes–your chance to prevent Type 2 diabetes. Reviewed 11 Jun 2020. https://www.cdc.gov/diabetes/basics/prediabetes.html#:~:text=Prediabetes%20is%20a%20serious%20health,t%20know%20they%20have%20it. Accessed 18 Oct 2021.
4. American Diabetes Association. Classification and diagnosis of diabetes. Diabetes Care. 2021;44(Suppl 1):S15–S33.
5. Cleveland Clinic website. Prediabetes: what is it, who’s at risk, can it be reversed? Reviewed 25 Mar 2021. https://my.clevelandclinic.org/health/diseases/21498-prediabetes. Accessed 18 Oct 2021.
6. American Diabetes Association website. Diagnosis. https://www.diabetes.org/a1c/diagnosis. Accessed 18 Oct 2021.
7. American Diabetes Association. Prevention or delay of type 2 diabetes. Diabetes Care. 2021;44(Suppl 1):S34–39
8. Evert AB, Dennison M, Gardner CD, et al. Nutrition therapy for adults with diabetes or prediabetes: a consensus report. Diabetes Care. 2019;42(5):731–754.
9. Centers for Disease Control and Prevention website. On your way to preventing Type 2 diabetes. Reviewed 10 Aug 2021. https://www.cdc.gov/diabetes/prevent-type-2/guide-prevent-type2-diabetes.html. Accessed 18 Oct 2021.
