From the Guidelines
Approximately 5-10% of people with non-diabetic hyperglycemia progress to type 2 diabetes each year, with about 70% eventually developing the condition over their lifetime if no intervention occurs. This progression rate varies significantly based on several factors including age, ethnicity, severity of initial blood glucose elevation, and presence of other risk factors such as obesity, family history, and physical inactivity 1. The criteria defining prediabetes, as outlined in the standards of medical care in diabetes-2021, include a fasting plasma glucose (FPG) of 100 mg/dL to 125 mg/dL, a 2-hour plasma glucose during a 75-g oral glucose tolerance test (OGTT) of 140 mg/dL to 199 mg/dL, or an A1C of 5.7-6.4% 1.
Key factors that influence the risk of progression from prediabetes to type 2 diabetes include:
- Age: The risk of developing type 2 diabetes increases with age 1
- Obesity: Excess weight itself causes some degree of insulin resistance, and most patients with type 2 diabetes have overweight or obesity 1
- Physical inactivity: Lack of physical activity is a significant risk factor for the development of type 2 diabetes 1
- Family history: A strong genetic predisposition or family history in first-degree relatives increases the risk of type 2 diabetes 1
- Ethnicity: Certain racial/ethnic subgroups, such as African American, American Indian, Hispanic/Latino, and Asian American, are at higher risk of developing type 2 diabetes 1
The transition from prediabetes to diabetes is not inevitable, however. Lifestyle modifications, including:
- Weight loss of 5-7% of body weight
- Regular physical activity (150 minutes per week of moderate exercise)
- Dietary changes can reduce the risk of progression by 40-70% 1. Medications such as metformin may be considered for high-risk individuals, particularly those with BMI >35, age <60, or women with a history of gestational diabetes, though lifestyle intervention remains the cornerstone of prevention 1. Regular monitoring with annual blood glucose testing is recommended for those with prediabetes to detect progression early 1.
From the Research
Non-Diabetic Hyperglycaemia and Type 2 Diabetes Progression
- The progression from non-diabetic hyperglycaemia to type 2 diabetes is a significant concern, with studies indicating that 5-10% of people per year with prediabetes will progress to diabetes 2.
- This progression is associated with insulin resistance and β-cell dysfunction, which can start before glucose changes are detectable 2.
- The risk of progression from non-diabetic hyperglycaemia to type 2 diabetes may decline with age, but the current definition of non-diabetic hyperglycaemia is not adjusted based on age 3.
Percentage of People with Non-Diabetic Hyperglycaemia Who Develop Type 2 Diabetes
- According to the study published in the Lancet, approximately 5-10% of people per year with prediabetes will progress to diabetes 2.
- This percentage may vary depending on individual factors, such as lifestyle and genetic predisposition, but overall, it highlights the importance of early intervention and prevention strategies.
Prevention and Intervention Strategies
- Lifestyle modification is considered the cornerstone of diabetes prevention, with evidence showing a 40-70% relative-risk reduction 2.
- Pharmacotherapy may also be beneficial in preventing the progression from non-diabetic hyperglycaemia to type 2 diabetes, although the choice of therapy should be individualized and based on patient-specific factors 2, 4, 5, 6.