Prediabetes

Prediabetes is a condition characterized by high blood sugar levels that are higher than normal but not high enough to be classified as diabetes. It is a warning sign that a person's glucose metabolism is becoming less efficient and that they are at increased risk of developing type 2 diabetes and other related health problems. Prediabetes affects approximately 84 million Americans and is considered a growing public health concern due to its link with obesity, lack of physical activity, and unhealthy diets.

Diagnosis

Prediabetes is typically diagnosed using the Hemoglobin A1c test, which measures the average blood sugar level over the past two to three months. A Hemoglobin A1c value between 5.7% and 6.4% indicates prediabetes, while a value of 6.5% or higher indicates diabetes. The American Diabetes Association also recommends the use of fasting glucose tests, which measures blood sugar levels after an 8-hour fast, or the oral glucose tolerance test, which measures blood sugar levels after drinking a sugary beverage.

Causes

The exact causes of prediabetes are not fully understood, but it is known that insulin resistance, obesity, physical inactivity, and unhealthy diets are major risk factors. Inactivity and unhealthy diets can lead to the accumulation of excess fat, particularly in the abdominal region, which can interfere with the body's ability to properly use insulin, leading to insulin resistance. This resistance results in high blood sugar levels and increased risk of type 2 diabetes.

Risk of diabetes

People with prediabetes are at increased risk of developing type 2 diabetes, heart disease, and other related health problems. They may also experience symptoms such as frequent urination, excessive thirst, and unexplained weight loss, although these symptoms are often mild and may go unnoticed.

Prevention

Preventing the progression from prediabetes to type 2 diabetes is crucial for maintaining overall health and preventing the development of related health problems. The most effective approach to preventing the progression of prediabetes is lifestyle modification, including a balanced diet, regular physical activity, and weight management. The American Diabetes Association recommends that people with prediabetes aim to lose 7% of their body weight and engage in physical activity for at least 150 minutes per week.

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Frequently asked questions

What Causes Prediabetes? The root cause of prediabetes and ultimately type 2 diabetes is insulin resistance.
How to Detect Prediabetes? You can take a prediabetes self-assessment test to determine if you might have prediabetes.
What are the Signs of Prediabetes? Some people may experience sugar spikes and crashes after consuming starchy meals, have weight gain in the central or upper body, or display symptoms of insulin resistance such as acanthosis nigricans. However, others may not have any noticeable symptoms other than a slight increase in blood sugar levels above 100, which falls within the diabetic range.
What is the Blood Sugar Level for Prediabetes? A normal fasting blood sugar level is 126 mg/dl. A fasting blood sugar level between 100-125 mg/dl is considered to be in the prediabetic range.
Can Prediabetes be Reversed with Diet? Yes, prediabetes and even early-stage type 2 diabetes can be reversed through a proper diet and exercise program under the guidance of an obesity medicine physician.
Is it Possible to Have Prediabetes without Knowing it? Yes, up to 90% of people with prediabetes are often unaware that they have it.
How Prevalent is Prediabetes? Prediabetes is very common and affects anywhere from a quarter to a third of the adult population in the United States. A report by the Centers for Disease Control and Prevention (CDC) found that over 100 million adults in the US are living with either prediabetes or diabetes. In 2015, 9.4% of the US population had diabetes (30.3 million people) and another 84.1 million had prediabetes.
What is the Connection Between Prediabetes and Metabolic Syndrome? Prediabetes refers to blood sugar levels in the prediabetic range of 100-125 mg/dl. However, there are other conditions that often accompany prediabetes, such as central obesity with a large waist and increased other factors.
Does Prediabetes Increase the Risk of Diabetes? Yes. Prediabetes raises the risk of developing type 2 diabetes, heart disease, and stroke. However, with prediabetes, there is the opportunity to make lifestyle changes to prevent or delay the onset of type 2 diabetes and other serious health problems.
What Leads to Prediabetes? Insulin, a hormone produced by the pancreas, acts as a key to allow blood sugar into cells to be used as energy. In prediabetes, the cells in the body do not respond to insulin normally. The pancreas produces more insulin to try to get the cells to respond, but eventually the pancreas can't keep up, leading to increased blood sugar levels and the development of prediabetes and type 2 diabetes.
Does Race and Ethnicity Influence the Risk of Prediabetes? Yes, race and ethnicity can play a role in the risk of prediabetes. African Americans, Hispanic/Latino Americans, American Indians, Pacific Islanders, and some Asian Americans are at a higher risk.
Can stress lead to prediabetes and type 2 diabetes? Stress can lead to an increase in cortisol levels, which can increase insulin resistance and blood sugar levels, potentially leading to prediabetes and type 2 diabetes. Additionally, stress-related overeating and sedentary behavior can also contribute to the development of these conditions. It is important to manage stress through activities such as exercise, meditation, and hobbies, as well as to maintain a healthy diet and lifestyle to lower the risk of developing prediabetes and type 2 diabetes.
What are the Risk Factors for Prediabetes? Some of the risk factors for prediabetes include:

Overweight
Age over 45
Family history of type 2 diabetes
Physical inactivity (less than 3 times a week)
Previous gestational diabetes or giving birth to a baby over 9 pounds
Polycystic ovary syndrome.

References

American Diabetes Association. (2021). Standards of medical care in diabetes-2021. Diabetes Care, 44(Supplement 1), S66-S77.
Centers for Disease Control and Prevention. (2021). Prediabetes. https://www.cdc.gov/diabetes/prevention/pdf/prediabetes-infographic.pdf
National Institute of Diabetes and Digestive and Kidney Diseases. (2021). Prediabetes. https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/prediabetes

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