Pre-Diabetes

Written By Adama Diarra, DO, FACP

What is Prediabetes?

With lab results getting released directly to patients without any context, I get this question almost daily in my clinical practice. Prediabetes is a condition where your blood sugar (glucose) levels are higher than normal but not yet high enough to be diagnosed as diabetes. It is essentially a warning sign that you are at risk of developing type 2 diabetes if no action is taken. Having prediabetes means your body isn't using insulin as efficiently as it should, leading to glucose buildup in the blood. Think of prediabetes as the tipping point—without intervention, it can lead to type 2 diabetes, but with the right steps, it can often be reversed or managed effectively.

The American Diabetes Association (ADA) estimates that around 1 in 3 American adults has prediabetes, and the majority don’t even know they have it. Since prediabetes often has no clear symptoms, it’s important to understand your risk factors and get tested if you're at risk.

Prediabetes develops when your body starts to lose its ability to properly regulate blood sugar, a process controlled by the hormone insulin. Several factors can contribute to the development of prediabetes:

1. Insulin Resistance

In prediabetes, your body’s cells begin to resist the effects of insulin, which means your cells don’t take in glucose as efficiently. Over time, this resistance increases, and the pancreas produces more insulin to try to compensate. Eventually, this can lead to consistently elevated blood sugar levels.

2. Risk Factors for Prediabetes

While anyone can develop prediabetes, some people are at a higher risk due to various factors, including:

  • Being overweight or obese: Excess body fat, particularly around the abdomen, is strongly linked to insulin resistance.

  • Family history of diabetes: Having a close relative with type 2 diabetes increases your risk of prediabetes.

  • Age: The risk of prediabetes increases after the age of 45.

  • Physical inactivity: A sedentary lifestyle contributes to weight gain and insulin resistance.

  • Unhealthy diet: Diets high in processed foods, sugary drinks, and unhealthy fats can increase your risk.

  • Polycystic ovary syndrome (PCOS): Women with PCOS are more likely to develop insulin resistance and prediabetes.

  • Gestational diabetes: Women who develop diabetes during pregnancy are at higher risk of developing prediabetes later in life.

Complications of Untreated Prediabetes

Without intervention, prediabetes can lead to several long-term health complications, the most serious being type 2 diabetes. Once a person develops type 2 diabetes, managing blood sugar levels becomes a lifelong task that often requires medications and regular monitoring.

If left untreated, prediabetes can lead to:

1. Type 2 Diabetes

When prediabetes progresses to type 2 diabetes, it brings an increased risk of:

  • Heart disease: People with diabetes are at a higher risk for heart attacks and strokes.

  • Kidney damage (nephropathy): High blood sugar can damage the blood vessels in the kidneys.

  • Nerve damage (neuropathy): Prolonged high blood sugar can cause damage to the nerves, leading to pain or numbness, particularly in the legs and feet.

  • Eye damage (retinopathy): Diabetes can damage the small blood vessels in the eyes, leading to vision loss and blindness.

2. Metabolic Syndrome

Prediabetes is often part of a cluster of conditions known as metabolic syndrome, which includes high blood pressure, high cholesterol, and excess abdominal fat. Together, these conditions increase the risk of cardiovascular diseases, such as heart attacks and strokes.

How to Manage and Treat Prediabetes

The good news is that prediabetes is reversible with early intervention. The goal is to prevent progression to type 2 diabetes, and this is most effectively achieved through lifestyle changes. However, if lifestyle changes alone aren’t enough, medications may be necessary.

1. Lifestyle-Based Management

Lifestyle changes are the cornerstone of managing prediabetes. The earlier you make these changes, the better your chances of reversing the condition.

Healthy Eating

A well-balanced diet is key to controlling blood sugar and preventing diabetes. Here are some tips:

  • Focus on whole foods: Eat plenty of fruits, vegetables, lean proteins, and whole grains. These foods help regulate blood sugar and promote weight loss.

  • Limit processed and sugary foods: Avoid foods high in refined carbohydrates and sugars, such as white bread, sugary snacks, and sugary drinks. These can cause blood sugar spikes.

  • Practice portion control: Keeping portions in check can help prevent overeating and manage weight, which is crucial for controlling blood sugar.

  • The Mediterranean Diet: Research shows that diets like the Mediterranean diet, which emphasizes healthy fats (like olive oil), lean proteins (like fish), and whole grains, can help lower blood sugar levels and reduce the risk of developing diabetes (Salas-Salvadó et al., 2011).

Regular Physical Activity

Exercise is another powerful tool in managing prediabetes. Regular physical activity helps your body use insulin more effectively and lowers blood sugar levels. Aim for at least 150 minutes of moderate-intensity exercise, such as walking, cycling, or swimming, each week.

Weight Loss

Losing even a small amount of weight—about 5-7% of your body weight—can significantly reduce your risk of progressing from prediabetes to type 2 diabetes. Studies have shown that weight loss improves insulin sensitivity and helps normalize blood sugar levels (Knowler et al., 2002).

Managing Stress

Chronic stress can affect your body’s ability to regulate blood sugar. Practices such as meditation, yoga, and deep breathing exercises can help manage stress and support healthy blood sugar levels.

2. Medications for Prediabetes

While lifestyle changes are the first line of defense, some patients may require medication if these measures alone aren’t enough. Your doctor may recommend medications if:

  • Blood sugar levels remain high despite lifestyle changes.

  • You have other risk factors, such as heart disease, that need to be managed.

Common medications for prediabetes include:

  • Metformin: This medication helps lower blood sugar by improving insulin sensitivity. It’s often prescribed for people who are at high risk of developing type 2 diabetes, particularly those who are overweight or have other risk factors (Diabetes Prevention Program Research Group, 2002).

It’s important to work closely with your doctor to develop a treatment plan that’s tailored to your specific needs. Every patient is different, and treatment should be personalized to fit your health profile and lifestyle.

Personalized Care for Every Patient

It’s important to remember that each patient’s journey with prediabetes is unique. Some people may be able to manage the condition with lifestyle changes alone, while others may need additional support from medications. Regular monitoring of your blood sugar, along with working closely with your healthcare provider, will help you create a treatment plan that’s right for you.

Conclusion

Prediabetes is a serious but manageable condition. The key is early detection and intervention. By making healthy lifestyle changes—such as improving your diet, exercising regularly, managing stress, and losing weight—you can often reverse prediabetes and prevent the onset of type 2 diabetes. And if lifestyle changes aren’t enough, medications like metformin can help you manage your blood sugar levels effectively.

Don’t wait for prediabetes to turn into something more serious. Take control of your health now by making small, sustainable changes and working with your healthcare provider to monitor your progress.

References:

  • Knowler, W. C., Barrett-Connor, E., Fowler, S. E., Hamman, R. F., Lachin, J. M., Walker, E. A., & Nathan, D. M. (2002). Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. The New England Journal of Medicine, 346(6), 393-403. https://doi.org/10.1056/NEJMoa012512

  • Salas-Salvadó, J., Bulló, M., Babio, N., Martínez-González, M. A., Ibarrola-Jurado, N., Basora, J., ... & Estruch, R. (2011). Reduction in the incidence of type 2 diabetes with the Mediterranean diet. Diabetes Care, 34(1), 14-19. https://doi.org/10.2337/dc10-1288

  • Diabetes Prevention Program Research Group. (2002). The Diabetes Prevention Program (DPP): Description of lifestyle intervention. Diabetes Care, 25(12), 2165-2171. https://doi.org/10.2337/diacare.25.12.2165