PREDIABETES (BORDERLINE DIABETES)

Prediabetes, often referred to as borderline diabetes, is a condition where blood sugar levels are higher than normal but not yet high enough to be diagnosed as type 2 diabetes. It’s a critical juncture where proactive steps can prevent the progression to full-blown diabetes. It’s often a precursor to type 2 diabetes, typically progressing without noticeable symptoms. Shockingly, over 80% of the estimated 98 million Americans with prediabetes are unaware of their condition.

Early intervention for prediabetes is crucial as it can prevent more severe health complications, including type 2 diabetes, as well as issues affecting the heart, blood vessels, eyes, and kidneys.

Other Terms for Prediabetes

Prediabetes may also be referred to by other names such as:

Impaired glucose tolerance (IGT)
Impaired fasting glucose (IFG)
Impaired glucose regulation (IGR)
Non-diabetic hyperglycemia

Causes of Prediabetes

Prediabetes typically results from insulin resistance, where the body produces insulin but fails to use it effectively, leading to elevated blood sugar levels. Contributing factors to insulin resistance include:

Genetic predisposition
Excess body weight
Chronic stress
Inadequate sleep
Sedentary lifestyle
Poor dietary habits, particularly consumption of processed foods
Certain hormonal disorders like Cushing’s syndrome and hypothyroidism
Prolonged use of medications such as steroids

Prevalence

Prediabetes is alarmingly common, with around 1 in 3 American adults affected. Globally, the prevalence is increasing due to rising obesity rates and sedentary lifestyles.

Symptoms of Prediabetes

While many individuals with prediabetes do not exhibit symptoms, some signs to watch for include:

Increased thirst
Frequent urination
Blurry vision
Persistent fatigue
Darkened skin patches in the armpits or neck area
Skin growths in the same regions

Specific Symptoms in Women

Women may experience additional symptoms related to prediabetes, such as:

Recurrent yeast and urinary tract infections
Longer and heavier menstrual periods
Reduced libido
Vaginal dryness leading to discomfort during intercourse
Difficulty conceiving

Risk Factors of Prediabetes

Several factors increase the likelihood of developing prediabetes:

Age: Individuals over 45 years old are at higher risk.
Waist Size: A waist circumference exceeding 40 inches for men (or those assigned male at birth) and 35 inches for women (or those assigned female at birth) is associated with increased risk.
Dietary Habits: Consuming excessive amounts of red and processed meats, sugary beverages, and insufficient fruits, vegetables, nuts, whole grains, or olive oil can elevate risk.
Ethnicity and Race: People of Black, Native American, Latino, or Pacific Islander descent face higher prediabetes rates.
Weight and Body Fat Distribution: Excess weight, particularly central obesity or belly fat, contributes to prediabetes risk.
Cholesterol Levels: Abnormal levels of cholesterol (high LDL or “bad” cholesterol, low HDL or “good” cholesterol), and elevated triglycerides increase susceptibility.
Physical Activity: Lack of regular exercise heightens the risk of prediabetes.
Gestational Diabetes: A history of gestational diabetes or delivering a baby weighing over 9 pounds increases risk.
Polycystic Ovary Syndrome (PCOS): Individuals with PCOS, a common hormonal disorder, are at higher risk.
Sleep Disorders: Conditions like sleep apnea can contribute to prediabetes risk.
Occupational Factors: Working in shifts or night shifts may increase susceptibility to prediabetes.

Importance of Testing

It’s crucial to undergo testing for prediabetes if:

Blood sugar readings are abnormal.
Heart disease is present.
Signs of insulin resistance are observed, including darkened skin patches, concentration difficulties, increased fatigue, or hunger.

Role of Race and Ethnicity

Certain racial and ethnic groups have higher prediabetes rates. Native Americans, Alaska Natives, non-Hispanic Black, Asian, and Hispanic adults are disproportionately affected. Disparities stem from factors like family health history, disparities in healthcare access, availability of healthy foods, and opportunities for physical activity. Understanding these risk factors can aid in early detection and prevention efforts.

Prediabetes and Gender

According to the CDC, prediabetes affects men at a slightly higher rate (41%) compared to women (32%).

Early studies suggested that gender-affirming hormone therapy might exacerbate insulin resistance and increase diabetes risk in transgender women. However, subsequent research has yielded conflicting results, necessitating further investigation into this area.

Diagnosis of Prediabetes

To diagnose prediabetes, your doctor may conduct one of the following tests:

Fasting Plasma Glucose Test:
- Conducted after an 8-hour fast, this test measures blood sugar levels.
- Results:
  - Normal: Less than 100 mg/dL
  - Prediabetes: 100-125 mg/dL
  - Diabetes: 126 mg/dL or higher
Oral Glucose Tolerance Test (OGTT):
- Following a fasting plasma glucose test, you’ll consume a sugary solution. Blood is then drawn 2 hours later for testing.
- Results:
  - Normal: Less than 140 mg/dL
  - Prediabetes: 140-199 mg/dL
  - Diabetes: 200 mg/dL or higher
Hemoglobin A1c Test:
- This blood test assesses average blood sugar levels over the past 2-3 months.
- Results:
  - Normal: 5.6% or less
  - Prediabetes: 5.7%-6.4%
  - Diabetes: 6.5% or above
- Confirmation may require repeating the test.

Prediabetes Testing in Children

Children aged 10 and older, particularly those with excess weight or obesity, should undergo prediabetes testing if they exhibit additional risk factors such as family history of type 2 diabetes, maternal gestational diabetes, or specific ethnic backgrounds. If initial tests yield normal results, reevaluation every 3 years is recommended for high-risk children.

Prediabetes is diagnosed through blood tests

Fasting Plasma Glucose Test: Blood sugar levels are measured after fasting for at least eight hours.

Oral Glucose Tolerance Test (OGTT): Blood sugar levels are tested before and two hours after consuming a sugary drink.
Hemoglobin A1c Test: Measures average blood sugar levels over the past 2-3 months.

Treatment of Prediabetes

The primary approach to managing prediabetes involves adopting a healthy lifestyle, encompassing the following steps:

Following a nutritious diet: Emphasize whole grains, fruits, vegetables, and lean proteins while limiting sugar and refined carbohydrates.
Achieving weight loss if necessary
Engaging in regular physical activity
Ceasing smoking habits
Maintaining optimal blood pressure and cholesterol levels

For individuals at high risk of progressing to diabetes, doctors may recommend medications like metformin (Glucophage) to help lower blood sugar levels. However, lifestyle modifications remain the cornerstone of prediabetes management.

Home Care Tip

While there’s no specific prediabetes diet, making certain dietary swaps can help reverse prediabetes and reduce the risk of developing type 2 diabetes:

Opt for whole grains and whole-grain products instead of processed carbohydrates like white bread and breakfast cereals.
Replace sugary beverages with healthier options such as coffee, water, and tea.
Choose healthy fats found in vegetable oils, nuts, and seeds over trans fats found in margarine and fried foods.
Substitute red and processed meats with nuts, whole grains, poultry, and fish.
Use olive oil instead of lard or butter for cooking.

Success with Type 2 Diabetes

Starting with small dietary changes can pave the way for better management of blood sugar levels:

Reduce portion sizes.
Incorporate an additional vegetable into meals.
Opt for roasting or baking foods instead of deep-frying.
Incorporate meat-free meals into your weekly routine.

Various healthy eating plans, such as the Mediterranean, plant-based (vegetarian or vegan), low-fat, or DASH (dietary approach to stop hypertension), can help lower the risk of diabetes. Consulting with a registered dietitian nutritionist (RDN) can assist in devising a personalized meal plan tailored to individual needs and preferences.

Exercise for Prediabetes

Regular physical activity plays a crucial role in managing prediabetes by utilizing blood sugar for energy and improving insulin sensitivity over time. Aim for at least 150 minutes of moderate exercise per week, ideally spread out over 30 minutes a day, five days a week. Suitable activities may include brisk walking, water aerobics, dancing, or biking. Additionally, integrating strength or resistance training exercises a few days a week can help build muscle mass.

Before starting any exercise regimen, especially if new to physical activity, consulting with a healthcare provider is advisable to ensure safety and suitability.

In addition to medical treatment, individuals with prediabetes can take steps at home to manage their condition:

Monitor Blood Sugar: Regularly check blood sugar levels at home as advised by the doctor.
Eat Healthily: Follow a balanced diet rich in fiber and low in processed sugars.
Stay Active: Incorporate regular physical activity into your daily routine.
Manage Stress: Practice stress-reduction techniques like meditation or yoga.

Complications of Prediabetes

Left untreated, prediabetes can progress to type 2 diabetes, potentially leading to severe complications such as:

Kidney disease
Vision impairment or blindness
Hypertension (high blood pressure)
Peripheral neuropathy (nerve damage)
Amputation due to limb loss

Moreover, even before advancing to diabetes, untreated prediabetes can cause lasting harm to blood vessels, kidneys, and the heart. It has been associated with silent heart attacks, characterized by subtle symptoms that may go unnoticed.

Prevention

Preventing prediabetes involves adopting healthy lifestyle habits:

Maintain a Healthy Weight: Aim for a body mass index (BMI) within the normal range.
Exercise Regularly: Engage in moderate-intensity exercise most days of the week.
Eat a Balanced Diet: Focus on whole foods and avoid excessive sugar and refined carbs.
Limit Alcohol: Drinking in moderation can help prevent prediabetes.
Get Regular Check-Ups: Screen for prediabetes and other health conditions regularly.

When to See a Doctor

Consult a healthcare provider if you experience symptoms of prediabetes or have risk factors such as obesity or a family history of diabetes. Early detection and intervention are key to preventing complications.

Outlook/Prognosis

The outlook for individuals with prediabetes is hopeful with early intervention. By adopting healthy lifestyle changes, many people can delay or even prevent the onset of type 2 diabetes and its associated complications.

Sources

American Diabetes Association. (n.d.).
American Diabetes Association
National Diabetes Clearinghouse
Mayo Clinic:
Harvard School of Public Health
CDC
Diabetes Care
StatPearls
Merck Manual Consumer Version
American Academy of Family Physicians
Diabetes UK
Cleveland Clinic
Northwell Health
Indian Health Service
Harvard Medical School
Centers for Disease Control and Prevention. (2020).
Mayo Clinic. (2021).

Borderline diabetes PREDIABETES