What Is Prediabetes?
Type 2 diabetes is the most common type of diabetes worldwide. However, the pathology takes a few years to develop. Before the establishment of the disease, people can have high blood glucose without suffering any specific symptoms, and this is a condition known as prediabetes.
This condition is a state in which blood glucose levels are higher than normal values, without reaching the criteria for the diagnosis of diabetes. This subclinical state is very frequent and the Centers for Disease Control and Prevention state that 88 million adults in the United States suffer from it.
Diagnosis of the condition is based primarily on measuring blood glucose levels. Fortunately, it’s a reversible condition, so proper treatment prevents its progression to type 2 diabetes.
Symptoms
In general terms, prediabetes doesn’t produce specific symptoms in those who suffer from it, so it goes unnoticed in most cases. This condition can remain stable for many years, without giving clear indications of its presence.
Some people may have a sign called acanthosis nigricans, which is the darkening of the skin in areas where there are skin folds. This sign occurs most frequently in the neck, although it can also appear in areas such as the armpits and groin. It’s usually accompanied by the growth of warts in the affected areas.
On very rare occasions, people with prediabetes can have symptoms that are very similar to those of type 2 diabetes, although with much less intensity. In this sense, patients may report any of the following manifestations:
- Excessive hunger or polyphagia
- Increased water intake or polydipsia
- Increase in voiding volume or polyuria
- Fatigue
- Changes in body weight
Causes and risk factors of prediabetes
Blood glucose levels can rise for two different reasons: when the body develops insulin resistance or when there’s insufficient production of the hormone. Insulin resistance is the main disorder related to prediabetes; it’s a condition in which the hormone isn’t able to introduce glucose into the cells.
Insulin is a hormone produced in the pancreas, whose main function is to introduce glucose from the plasma into the cells so that it can be used as energy. This hormone isn’t able to exert its function when the body creates resistance to it, which is why a high blood glucose level is maintained.
Besides this, insulin resistance can cause the pancreas to stop working properly, decreasing the production of the hormone after a while. In this sense, both conditions favor the appearance of prediabetes and its subsequent evolution to type 2 diabetes.
Risk factors
A precise cause for prediabetes has not yet been determined, however, there are a large number of risk factors that increase its likelihood of onset. Most of them are related to the lifestyle of the people, so they can be modified. Among the main factors that predispose to the appearance of the alteration, the following stand out:
- Being overweight and obese
- Maintaining a sedentary lifestyle
- Having a diet rich in carbohydrates and fats
- Have a lot of abdominal fat
- Uncontrolled hypertension and high levels of cholesterol in the blood
- Be over 45 years old
Diagnosis
It’s important to bear in mind that the majority of patients with prediabetes don’t show any characteristic symptoms. In most cases, this condition is diagnosed by chance after a routine blood test.
For their part, the specialist must also take into account the risk factors present in order to recommend a test.
The blood tests recommended to diagnose this condition are similar to those used in the diagnosis of type 2 diabetes. In this sense, blood sugar levels must be measured in order to detect the condition.
According to the American Diabetes Association (ADA), both fasting plasma glucose, the oral glucose tolerance test, and glycated hemoglobin allow the diagnosis to be made. Each of them must show specific concentrations of glucose in the blood, which are the following:
- Fasting plasma glucose between 100 and 125 milligrams per deciliter
- Oral glucose tolerance test between 140 and 199 milligrams per deciliter
- Glycated hemoglobin between 5.7 and 6.4%
In many cases, multiple blood tests may be necessary before making an accurate diagnosis. This is because blood glucose levels can be momentarily altered by changes in diet, stressful situations, or physical activity.
Treatment of prediabetes
The first option in the treatment of prediabetes is to make lifestyle changes, something very similar to what happens in the treatment of type 2 diabetes. In this sense, one of the main measures that must be taken is to lose weight, even a moderate weight loss can greatly decrease glycemia.
Regular physical activity or exercise can also help improve the condition. Muscle contraction increases glucose entry into cells and improves short-term insulin sensitivity. In this way, it’s recommended to do at least 30 minutes of aerobic-type exercises 5 days a week.
Diet changes are just as important as the previous two measures. The most advisable thing is to reduce the intake of carbohydrates, saturated fats, and foods rich in processed sugars. In turn, it’s necessary to increase the intake of fruits and vegetables up to a recommended maximum of 2.5 cups per day.
On the other hand, studies show that some antidiabetic drugs and bariatric surgery are also useful in the treatment of prediabetes. The intake of metformin, alpha-glucosidase inhibitors, pancreatic lipase inhibitors, meglitinides, and GLP-1 agonists have shown great results in reversing this condition.
Associated complications
The main complication of prediabetes is its evolution to type 2 diabetes mellitus. In fact, studies show that each year between 5 and 10% of patients diagnosed with this disorder develop the disease. In this sense, timely treatment is essential in order to reverse the situation.
This condition also causes damage to the blood vessels and the microvasculature, which is why it’s possible to develop cardiovascular diseases, even before its progression to diabetes. On the other hand, it’s also associated with an early form of diabetic retinopathy, kidney disorders, and neuropathies.
Preventing prediabetes is essential
Fortunately, prediabetes is a preventable condition despite having certain risk factors present. In this sense, it’s important to have a more active life and to maintain a healthy and balanced diet. These measures help the body keep blood glucose levels in the correct range.
All people diagnosed with this condition must follow the treatment indicated for each particular case and maintain periodic medical control. It’s important to note that it’s possible to slow down the deterioration of the physical condition and prevent the onset of type 2 diabetes, but this requires a change in lifestyle.
- Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2020. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Dept of Health and Human Services; 2020.
- American Diabetes Association. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes—2021. Diabetes Care. 2020;44(Supplement 1):S15-S33.
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