From the Guidelines
Prediabetes education should prioritize lifestyle modifications, including a 7% weight loss goal and at least 150 minutes of moderate-intensity physical activity per week, as the primary intervention to prevent or delay the onset of type 2 diabetes. According to the most recent and highest quality study 1, patients with prediabetes should be referred to an intensive behavioral lifestyle intervention program to achieve and maintain weight loss and increase physical activity.
Key Recommendations
- Patients should aim for a 7% weight loss through a combination of dietary changes and increased physical activity 1
- Diet recommendations include reducing calorie intake, limiting refined carbohydrates and added sugars, increasing fiber intake, and following a Mediterranean or DASH diet pattern
- Physical activity goals should include at least 150 minutes of moderate-intensity exercise weekly, with resistance training 2-3 times per week
- Medication therapy with metformin may be considered for high-risk individuals, particularly those with BMI >35, age <60, or prior gestational diabetes 1
- Education should emphasize that prediabetes is reversible and that these interventions can prevent or delay progression to type 2 diabetes by reducing insulin resistance and preserving beta-cell function
Importance of Follow-up
Regular follow-up with healthcare providers every 3-6 months is important to monitor progress and adjust interventions as needed 1. At least annual monitoring for the development of diabetes in those with prediabetes is suggested 1.
Additional Considerations
People with prediabetes often have other cardiovascular risk factors, such as obesity, hypertension, and dyslipidemia, and are at an increased risk for cardiovascular disease events 1. Treatment goals are the same as for other patients without diabetes, but increased vigilance is warranted to identify and treat these and other risk factors. Diabetes self-management education and support programs can also apply to the education and support of people with prediabetes 1.
From the Research
Definition and Risks of Prediabetes
- Prediabetes is defined as impaired fasting glucose and/or impaired glucose tolerance, with fasting blood glucose between 5.6 mmol/L and 6.9 mmol/L (100.8-124.2 mg/dL), and impaired glucose tolerance is the 2-hour oral glucose tolerance test of 7.8-11.0 mmol/L (140.4-198.0 mg/dL) 2.
- Prediabetes increases the risk of development of type 2 diabetes, and individuals with prediabetes are at greater risk of type 2 diabetes (T2D) 2, 3.
- Prediabetes is also associated with increased risk of cardiovascular events and mortality 4, 5.
Lifestyle Modification and Pharmacological Interventions
- Lifestyle modification, including diet and exercise, is the first line of treatment for individuals with prediabetes, and is effective at reducing the incidence of T2D and improving glycemic control 2, 4.
- Intensive lifestyle modification, consisting of calorie restriction, increased physical activity, self-monitoring, and motivational support, decreased the incidence of diabetes by 6.2 cases per 100 person-years during a 3-year period 4.
- Pharmacological interventions, such as metformin, can also prevent the progression of prediabetes to type 2 diabetes, with a risk reduction of 14 to 72% in clinical studies 3, 4.
Screening and Diagnosis
- There are different definitions of prediabetes based on different cut points of HbA1C, fasting glucose, and 2-h glucose, which can make it challenging to diagnose and treat prediabetes 5.
- Establishing consensus definitions for prediabetes is a priority, and will help inform expansion of insurance coverage for lifestyle modification and improve current screening and diagnostic practices 5.
- A test and treat approach for prediabetes, which involves screening and identification of individuals with prediabetes followed by prompt referral to structured lifestyle modification programs or pharmacologic interventions, can be effective in preventing or delaying the progression to type 2 diabetes 6.