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What is prediabetes?







What is prediabetes or borderline diabetes?

Put simply

Prediabetes is a condition that describes a person who has a number of abnormal glucose blood tests suggesting they have borderline diabetes. It may also be called “impaired glucose tolerance” or “metabolic syndrome”. People with Prediabetes are very likely to progress to developing diabetes in the coming few years. More importantly, people with prediabetes are the most likely to recover and return back to normal by making a few important changes.


The more complex story

Type 2 diabetes is rapidly becoming one of the most common long-term diseases in the world. The problem causing an elevation in the blood glucose levels occurs when there is a change in the shape of the insulin receptor. In the normal situation, the body produces a small chemical called insulin (key) whose purpose is to bind to a receptor (lock) on the surface of fat and muscle cells, opening a channel to allow glucose to enter those cells. In type 2 diabetes the shape of this receptor changes mostly as a consequence of weight gain around the stomach.

What is metabolic syndrome

Metabolic syndrome, sometimes called syndrome X, is a collection of disorders, including high blood pressure, insulin resistance, abnormal cholesterol levels, and excess fat around the waist. People with metabolic syndrome are twice as likely to have a heart attack and stroke, and five times more likely to develop type 2 diabetes, compared to people without metabolic syndrome.



Over the past three decades, the prevalence of metabolic syndrome has increased. More and more young people are showing signs of metabolic syndrome. The incidence of metabolic syndrome often parallels the incidence of type 2 diabetes and obesity (The Global Epidemic of the Metabolic Syndrome). According to the Centers for Disease Control and Prevention (CDC), 12.2% or 30.2 million adults (aged 18 years and older) in the USA had type 2 diabetes in 2017. What’s scary, is that a quarter of these adults, don’t even realise that they have diabetes.



Who is at risk of prediabetes?

Risk factors can be divided into non-modifiable risk factors and modifiable risk factors. Non-modifiable risk factors are those that can’t be changed by you, for example your genetics. Modifiable risk factors can be changed, for example making changes to the amount you exercise.


Non-modifiable risk factors in prediabetes?

Diabetes is much more common in people from certain ethnic backgrounds like Indian, Middle Eastern, south-east Asian and indigenous populations. In these groups rates of diabetes can approach 30% of the adult population. In Caucasian populations, the rates are more typically 10% of the adult population.

The non-modifiable risk factors which increase your chance of developing prediabetes include:

  • Have a family history of diabetes
  • Being older (over 55 years of age) – the risk increases as we age
  • Ethnic background, including Aboriginal and Torres Strait Islanders, Pacific Islanders, Asian and South East Asian, African Americans, Native Hawaiians, and Hispanics/ Latinos

Being aware of the non-modifiable risk factors is extremely important. For people who have a family history of type 2 diabetes, you need to be more alert and start taking action early to prevent or delay developing type 2 diabetes.


Modifiable risk factors in prediabetes

The modifiable risk factors which increase your chance of developing prediabetes include:

  • Being overweight or obese, particularly extra weight around the waist
  • Being physically inactive
  • Eating a poor diet (one that is high in fat, salt, and sugar)
  • High blood pressure



What are the symptoms of prediabetes or borderline diabetes?

The most common symptom of diabetes is feeling nothing at all. Yes, nothing. That’s part of the problem. A person with undiagnosed prediabetes feels ok but the damage is already occurring. Many people experience tiredness and fatigue, and that is really noticed when you start to get sugars under control.

In type 2 diabetes, the general symptoms include:

  • Fatigue and irritability
  • Excessive thirst, frequent urination, and dehydration
  • Ongoing hunger
  • Yeast and bacterial infections
  • Dry and itchy skin
  • Cuts and wounds that don’t heal quickly
  • Pain and numbness in your feet or legs
  • Blurred vision
  • Changes in weight

Some symptoms of diabetes can vary between men and women. Symptoms of type 2 diabetes mellitus in men are often related to sexual health and function. The symptoms of type 2 diabetes in women also often relate to sexual health and function.



How is prediabetes diagnosed?

Diagnosing diabetes can often happen by chance. Most people diagnosed with prediabetes are picked up by chance based on a high blood glucose reading noticed during routine blood testing. It is not the best way to test for diabetes and so more formal tests should be asked for. This is typically a glucose tolerance test or another test called an HbA1c. A glucose tolerance test involved a fasting blood test, 75g of glucose as a sugary drink followed by another test of blood sugar taken 2 hours later. Prediabetes is diagnosed when the sugar is too high to be normal and not high enough to have diabetes diagnosed.

Diagnosing diabetes should not rely solely on using a Hb A1c test.



What is the diagnostic criteria for prediabetes?

Below is the diagnostic criteria for someone with prediabetes.


Diagnostic blood glucose levels for prediabetes
Test mmol/L mg/dL
Impaired Fasting Glucose (IFG) 5.5 – 6.9 mmol/L 100 – 125 mg/dL
Impaired Glucose Tolerance (IGT) 7.8 – 11.0 mmo/L (2 hr plasma glucose) 140 – 196 mg/dL (2 hr plasma glucose)




Does prediabetes develop and progress into type 2 diabetes?

Unfortunately for many people with borderline diabetes they are likely to progress to developing type 2 diabetes. If left untreated, 37% of people with prediabetes will go on to develop type 2 diabetes mellitus in 4 years (Prediabetes and Lifestyle Modification: Time to Prevent a Preventable Disease).



How often should I be tested for type 2 diabetes?

If you have been diagnosed with prediabetes, you should be tested every 12 months for type 2 diabetes.



Is prediabetes dangerous and can it cause problems?

Diabetes is a very serious condition. People with borderline diabetes are at an increased risk of heart attacks and strokes, as well as some cancers. Even though blood glucose levels are only mildly elevated, people can still have abnormalities with their cholesterol levels and high blood pressure (hypertension). These factors also contribute to the high rates of heart disease seen in people with diabetes.

People with diabetes who have ongoing high blood glucose levels, are at an increased risk of having poor health outcomes compared to people who do not have diabetes. Here are some important facts that you need to know that relate to people with diabetes:

  • People with diabetes are up to four time more likely to suffer heart attacks or strokes
  • Diabetes is the leading cause of vision-loss globally and is the fifth most common cause of preventable blindness and fifth more common cause of moderate to severe visual impairment
  • Kidney failure is three times more common in people with diabetes
  • Amputations are 15 times more common in people with diabetes
  • More than 30 percent of people with diabetes experience depression, anxiety, and distress
  • Early diagnosis, optimal treatment, and effective ongoing support and management reduce risk of diabetes-related complications dramatically.



What are complications of prediabetes?

If left untreated, prediabetes can become type 2 diabetes. Type 2 diabetes is associated with a number of complications affecting the blood vessels in our body. Complications in type 2 diabetes can be described as microvascular (small blood vessels) or macrovascular (large blood vessels) complications (Microvascular and Macrovascular Complications of Diabetes). Diabetes-related complications occur over time due to persistent high blood glucose levels, high blood pressure, and abnormal cholesterol levels. These complications are serious and can be life-threatening.



Macrovascular complications - Problems with large blood vessels

Macrovascular disease affects the larger blood vessels in our body that supply blood to the heart, brain, and legs. Macrovascular complications include:

  • Coronary artery disease which can lead to a heart attack
  • Cerebrovascular disease which can lead to a stroke
  • Peripheral artery disease which can lead to pain deep in the leg muscles (calves, thigh, or buttocks) during activity as well as amputations.


Microvascular complications – problems with small blood vessels

Like macrovascular disease, ongoing high blood glucose levels are an important risk factor for the development of microvascular disease in patients with type 2 diabetes. Microvascular complications include:

  • Retinopathy – Disease of the eye which can lead to blindness
  • Neuropathy – Disease of the nerves which can lead to foot ulcers requiring amputation
  • Nephropathy – Disease of the kidneys which can lead to kidney failure and the need for dialysis



How can I prevent prediabetes from progressing to type 2 diabetes?

There are changes you can make to improve your health and prevent type 2 diabetes. For people with prediabetes, lifestyle modification can lead to a 40-70% reduction in risk of developing type 2 diabetes (Prediabetes: A high-risk state for developing diabetes). You can prevent type 2 diabetes through:

  • Eating well
  • Moving your body more
  • Being a healthy weight
  • Setting realistic goals
  • Getting support
  • Make changes part of your everyday


There is also some evidence that suggests quitting smoking can help to reduce your risk of developing diabetes. While there still needs to be more research done in this by scientists, there are plenty of other great reasons to quit smoking. For example, quitting smoking can help to lower your risk of having a stroke or heart attack.

Making these changes can also help to reduce your risk of developing diabetes comorbidities; hypertension and dyslipidemia.

If you have prediabetes, the personalised 12-week prediabetes program can be tailored to your needs. It can provide you with the best advice to help you get back on track and prevent prediabetes from becoming type 2 diabetes.



Metformin and prediabetes

Metformin is often prescribed to people with prediabetes who are at a high risk of developing type 2 diabetes. Metformin works to keep lower blood glucose levels by preventing the liver from making more glucose when you don't need anymore.

For more information about metformin, you can read about the benefits of metformin and starting on metformin - what you need to know.



Can prediabetes be reversed?

Yes yes yes!! Prediabetes can be reversed. The greatest chance of reversing prediabetes and avoiding type 2 diabetes, is by tacking action now. Many studies have demonstrated a 5% reduction in body weight (for most people this is 5kg) can reduce the chance of developing diabetes by 40%. The sooner you start, the greater pancreatic function remains, the better your chances. Whether it is reversible or not does not change that fact improving your diet and exercise and using the right medication all lead to dramatic improvements. Fundamentally, it is not diabetes that damages the body but high blood sugars.



What should a person with prediabetes do?

The first thing to do once diagnosed with prediabetes is to improve your knowledge. This is a disease that is not solved in the doctors' office but rather by making the right choices most of the time. Our understanding of diabetes and how to control it has improved dramatically, and yet still most people with diabetes have not been given the tools or understanding to be involved in the management of their condition.

You can improve your knowledge by joining our 12-week personalised diabetes program. The program will provide you with all of the information that you need, while motivating you to stay on track. When you sign up, you receive the first week free!