From the Guidelines
Pre-diabetes is a health condition where blood sugar levels are higher than normal but not yet high enough to be diagnosed as type 2 diabetes, characterized by a fasting blood glucose level between 100-125 mg/dL, an A1C test result between 5.7% and 6.4%, or a glucose tolerance test result between 140-199 mg/dL, as defined by the American Diabetes Association standards of medical care in diabetes-2021 1.
Definition and Diagnostic Criteria
Pre-diabetes occurs when the body becomes resistant to insulin or doesn't produce enough insulin to maintain normal blood glucose levels. The diagnostic criteria for pre-diabetes include:
- Fasting plasma glucose (FPG) levels between 100 mg/dL (5.6 mmol/L) and 125 mg/dL (6.9 mmol/L)
- 2-hour plasma glucose (2-h PG) during a 75-g oral glucose tolerance test (OGTT) between 140 mg/dL (7.8 mmol/L) and 199 mg/dL (11.0 mmol/L)
- A1C levels between 5.7% and 6.4% (39-47 mmol/mol) 1
Risk Factors and Screening
Pre-diabetes often has no clear symptoms, making regular screening important, especially for individuals with risk factors such as:
- Being overweight or obese
- Being over 45 years old
- Having a family history of diabetes
- Leading a sedentary lifestyle Screening for pre-diabetes and type 2 diabetes risk through an informal assessment of risk factors or with an assessment tool, such as the ADA risk test, is recommended to guide providers on whether performing a diagnostic test is appropriate 1.
Reversal and Prevention of Progression
Pre-diabetes is reversible through lifestyle modifications, including:
- Weight loss of 5-7% of body weight
- Regular physical activity (at least 150 minutes per week of moderate exercise)
- Dietary changes focusing on reduced carbohydrates, especially refined sugars Without intervention, pre-diabetes commonly progresses to type 2 diabetes within 5-10 years, which brings more serious health complications like heart disease, stroke, and kidney problems 1.
Monitoring and Follow-up
Regular monitoring of blood glucose levels is essential for those diagnosed with pre-diabetes, with at least annual monitoring for the development of diabetes recommended 1.
From the Research
Definition of Pre-Diabetes
- Pre-diabetes is defined as a state of abnormal glucose homeostasis where blood glucose levels are elevated above those considered normal, but not as high as those required for a diagnosis of diabetes 2.
- It is characterized by a fasting glucose level of 100 to 125 mg/dL, a glucose level of 140 to 199 mg/dL measured 2 hours after a 75-g oral glucose load, or glycated hemoglobin level (HbA1C) of 5.7% to 6.4% or 6.0% to 6.4% 3.
- Pre-diabetes is also known as intermediate hyperglycaemia, and it is a high-risk state for diabetes development 4.
Prevalence and Risk Factors
- Pre-diabetes affects 1 in 3 adults in the US and approximately 720 million individuals worldwide 3.
- Approximately 10% of people with pre-diabetes progress to having diabetes each year in the US 3.
- Pre-diabetes is associated with an increased risk of diabetes, cardiovascular events, and mortality 3, 4.
- Risk factors for pre-diabetes include insulin resistance and β-cell dysfunction, which can start before glucose changes are detectable 4.
Treatment and Prevention
- Intensive lifestyle modification, consisting of calorie restriction, increased physical activity, self-monitoring, and motivational support, can decrease the incidence of diabetes by 6.2 cases per 100 person-years during a 3-year period 3.
- Metformin can decrease the risk of diabetes among individuals with pre-diabetes by 3.2 cases per 100 person-years during 3 years 3.
- Pioglitazone has been shown to reduce or delay the development of type 2 diabetes in people at increased risk of type 2 diabetes compared with placebo and compared with no intervention 5.
- Lifestyle modification is considered the cornerstone of diabetes prevention, with evidence of a 40-70% relative-risk reduction 4.