What you need to know about Prediabetes

What is prediabetes?

Prediabetes is a condition in which blood sugar levels are higher than normal but not high enough to qualify for the diagnosis of diabetes.

How is prediabetes diagnosed?

Either by a blood sugar test after an overnight fast (fasting blood sugar) or measuring the blood sugar level 2 hours after drinking a standardized sugar (glucose) solution. If the fasting blood sugar is higher than normal (100 mg%) but not high enough to be called diabetes (126 mg % or higher), prediabetes known as “impaired fasting glucose” (IFG) is present. If 2 hours after the standardized glucose solution, the blood sugar is between 140 mg% and 200 mg%, prediabetes known as “impaired glucose tolerance” (IGT) is present. An individual can have both.

Why is knowing if you have prediabetes important?

Because prediabetes is a strong predictor of eventual diabetes. Action should be taken to delay the appearance of diabetes by dietary guidance, caloric restriction if overweight or obese and a regular moderate exercise program. These lifestyle tactics have been shown in studies to delay or prevent the appearance of diabetes. Although no medications are FDA approved for use in prediabetes, some studies have demonstrated the ability of certain medications that are used in diabetes to delay the progression from prediabetes to diabetes. These are occasionally used in certain situations.

Are there other complications of prediabetes other than the future risk for diabetes?

Yes. Persons with prediabetes actually have some of the same complications as persons with diabetes, only less frequently. For example, a certain number of persons with prediabetes will have diabetic eye disease (retinopathy), nerve damage (neuropathy) and early diabetic kidney disease (nephropathy) with excess protein in the urine. Also, it is generally believed that patients with prediabetes already have an increased risk of heart and blood vessel disease although not as high as those with diabetes.

What are the treatments for prediabetes?

First and foremost, as mentioned above, dietary measures usually in the form of calorie and carbohydrate restriction designed to promote weight loss. Secondly, a regular moderate aerobic exercise program of approximately 30 minutes per day, 5 days a week. Both of these strategies have been shown in studies to delay or prevent the transition to diabetes. Occasionally, certain diabetes medications are used to prevent or delay the progression to diabetes as well.

Since some diabetic complications may already appear in prediabetes and an increased risk for heart and blood vessel disease already exists in prediabetes, aggressive control of both high blood pressure and elevated cholesterol to the same degree as in diabetes is necessary and is recommended. This often, but not always, requires medication to lower blood pressure and cholesterol.

Paul S. Jellinger, MD, MACE, is a Professor of Medicine on the voluntary faculty at the University of Miami. After receiving his medical degree from Wayne State University School of Medicine, Dr. Jellinger completed a first-year medical residency at Beth Israel Hospital and a second-year residency at Mount Sinai Hospital in New York City. He, subsequently, was awarded an NIH fellowship in Endocrinology at Mount Sinai Hospital. Dr. Jellinger is a founding member of the American Association of Clinical Endocrinologists (AACE). He lectures frequently on topics related to diabetes mellitus and lipid disorders.