Diabetes is a condition that occurs when the body isn’t able to turn sugar (glucose) into energy, which is a natural process involving the hormone insulin. The condition affects more than 29 million Americans.
In people with diabetes, their bodies either don’t make enough insulin or don’t use insulin properly. Glucose does not move into the cells normally, which causes an increase in blood glucose levels. Over time, if left untreated, high blood glucose levels can cause serious health problems.
Prediabetes is a condition in which blood glucose levels are elevated, indicating that a person is at risk of progressing to type 2 diabetes. According to the Center for Disease Control and Prevention (CDC), prediabetes also puts you at increased risk of heart disease and stroke.
“Diabetes and prediabetes are not like an infection – which you either have or you don’t,” explains Smriti Manandhar, MD, an endocrinologist at UPMC Western Maryland. “They are more like a spectrum where certain factors put you at higher or lower risk. Genetics and age can’t be changed, but a person’s dietary choices and weight can be modified to lower their risk of diabetes and thereby the complications.”
Approximately 96 million American adults — more than 1 in 3 — have prediabetes. Without treatment, nearly 30 percent of people with prediabetes will develop type 2 diabetes within five years. However, more than 8 out of 10 people don’t even know they have prediabetes.
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Three Common Types of Diabetes
Type 1 diabetes is most common in children and young adults. With this type, the pancreas doesn’t make insulin.
Type 2 diabetes is the most common type. It develops when the body doesn’t produce enough insulin, or the cells ignore the insulin, which is called insulin resistance.
Gestational diabetes is a type that can develop during pregnancy as a result of hormonal changes. Gestational diabetes typically disappears after delivery; however, these women have a 50 percent higher risk for developing type 2 diabetes over their lifetimes.
Prediabetes is the stage right before a person develops type 2 diabetes. It is characterized by blood glucose levels that are higher than normal, but not yet high enough to be considered diabetes.
Although there are no clear symptoms of prediabetes, there are some risk factors to be aware of. While a person with prediabetes may have lower blood sugar than someone with type 2 diabetes, they both share the same risk factors.
Risk factors for both types are:
- Weight – A primary risk factor: The more fatty tissue you have, the more resistant your cells become to insulin.
- Family history and genetics – Your risk of prediabetes increases if you have a parent or sibling with type 2 diabetes.
- Waist size – A larger waist size can indicate insulin resistance. The risk goes up for men with waists larger than 40 inches and for women with waists larger than 35 inches.
- Diet and nutrition — Eating red or processed meat and drinking sugar-sweetened beverages increase the risk. A diet high in fruits, vegetables, nuts, whole grains, and olive oil lowers your risk.
- Inactivity — Physical activity helps you control your weight, uses glucose as energy, and makes your cells more sensitive to insulin. Simply walking more combats this risk factor.
- Age — Although diabetes can develop at any age, the risk of prediabetes increases after age 45. This may be because people tend to exercise less, lose muscle mass, and gain weight as they age.
- Race/ethnicity — Certain people have a higher risk of developing the disease due to insulin resistance. They include Black Americans, Hispanics, Native Americans, Native Alaskans, Asian Americans, and Pacific Islanders.
- High blood pressure.
- Gestational diabetes — If your baby weighed more than 9 pounds at birth or you had gestational diabetes while pregnant, you’re at increased risk.
- Polycystic ovary syndrome. — This common condition increases a person’s risk of prediabetes.
- Sleep disorders — Certain sleep problems – such as sleep apnea — increase the risk of insulin resistance. Those who have jobs with changing shifts or night shifts also may have an increased risk of prediabetes or type 2 diabetes.
If you’ve been told you are at risk for prediabetes, Dr. Manandhar says there are a number of tests that your doctor may order to confirm the diagnosis. The American Diabetes Association (ADA) recommends that screenings for adults begin at age 45. If a person is overweight and has additional risk factors, they should start earlier. The tests include:
Fasting plasma glucose (FPG) test
The fasting plasma glucose screen checks your blood glucose levels after not eating or drinking anything other than water for the previous eight hours. These scores are presented in terms of milligrams per deciliter:
- Normal results are less than 100mg/dl.
- Prediabetes is 100 mg/dl to 125 mg/dl.
- Diabetes is diagnosed at equal to or over 126 mg/dl.
Oral glucose tolerance test
The oral glucose tolerance test (OGTT) is a two-hour test which checks your blood glucose levels before and again two hours after you consume a provided drink. The results of this test will indicate how your body processes glucose. The results of this test also are given in milligrams per deciliter:
- Normal is considered less than 140 mg/dl.
- Prediabetes ranges from 140 to 199 mg/dl.
- The diabetes range is anything higher than 200 mg/dl.
This test measures your average blood glucose level over the previous two or three months. The test measures the percentage of blood sugar attached to proteins in red blood cells (hemoglobin). The higher your blood sugar levels, the more sugar you’ll have attached to the hemoglobin. The results are given in percentages:
- Normal is less than 5.7%.
- Prediabetes is 5.7 to 6.4%.
- Diabetes is anything equal to or higher than 6.5%.
Unlike other tests, the A1C does not involve fasting from food or drinks.
Preventing Type 2 Diabetes
“Being diagnosed with prediabetes may be a wake-up call to alert you that you’re on the path to diabetes – but it’s not too late to turn things around,” says Dr. Manandhar. “It doesn’t necessarily mean that you will be diagnosed with diabetes. There are a number of lifestyle changes that can help delay or reverse the course of prediabetes.”
Dr. Manandhar recommends:
- Eating a balanced meal with adequate fiber content.
- Consuming fewer sugary drinks, refined carbohydrates, and processed fats.
- Quitting smoking.
- Increasing physical activity to at least 150 minutes per week.
- Losing 5 percent to 7 percent of your bodyweight and maintaining the weight loss.
By changing some of your eating habits and getting more exercise, you have the ability to bring your blood sugar level back toward normal. “I encourage those with prediabetes to visit the CDC’s National Diabetes Prevention Program website,” Dr. Manandhar says. “The NDPP works in partnership with health care organizations to help people prevent or delay type 2 diabetes. There are program partners across the U.S. that can help people find lifestyle change programs in their local area.”
Research shows that it’s never too late to realize health benefits by making lifestyle changes — even in middle age. One study showed a 58 percent overall reduction in risk of developing diabetes after lifestyle interventions for people of all ages. But in people ages 60+, the study showed an even greater risk reduction of 70 percent.
That study also showed that the onset of diabetes was delayed by four years when participants who made lifestyle changes still went on the develop type 2 diabetes.
The American Diabetes Association offers an interactive quiz that can help you determine if you are at risk of prediabetes. The questions ask about age, gender, family history, height, and activity level.
Remember: Now is not the time to panic, as there is good news that comes with the diagnosis of prediabetes. You now have the opportunity to improve your overall health while also stopping the progression from prediabetes to type 2 diabetes.
To learn more about diabetes, treatment, and prevention, talk to your doctor or visit UPMC Centers for Diabetes Education and Support.
Editor's Note: This article was originally published on , and was last reviewed on .
The UPMC Department of Endocrinology stands as a national leader in research of diabetes and endocrine conditions. We partner with the University of Pittsburgh Division of Endocrinology and Metabolism for research and clinical trials. We treat diabetes, obesity, osteoporosis, hormonal disorders, and thyroid disorders at several locations across our communities. We also have specialized Diabetes Centers to help you manage your disease. Find an expert near you.