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Prediabetes: Am I At Risk?

Medically reviewed on Mar 25, 2018 by L. Anderson, PharmD.

What is Early Diabetes and Its Risk Factors?

Did you know that type 2 diabetes usually gives you an early warning alert? It's important to know this because early diabetes (prediabetes) can put a patient at high risk for developing full on type 2 diabetes. However, you can reverse your prediabetes before it's too late.

Doctors sometimes refer to prediabetes as impaired glucose tolerance (IGT) or impaired fasting glucose (IFG). Prediabetes means your blood sugars (glucose) are high, but not high enough to be officially diagnosed with diabetes. People with prediabetes may also have insulin resistance, a condition in which the body does not use insulin effectively.

Other risk factors for diabetes include:

  • age over 40
  • overweight or obese
  • family history of diabetes
  • inactivity and lack of exercise
  • fat distributed primarily to the stomach area
  • non-caucasian
  • history of gestational diabetes
  • polycystic ovary syndrome.

Your doctor can take a history and physical and complete lab testing to determine your type 2 diabetes status. Follow along to learn more.

Should I Be Tested for Prediabetes or Diabetes?

Guidelines have slight different recommendations, but in general, follow these recommendations:

  • If you are over 40 years and overweight or obese, get tested, as recommended by the USPSTF. Screening for abnormal blood glucose should be part of a heart disease risk assessment.
  • If your weight is normal but you are over 40 to 45 years, ask your doctor if your risk profile requires screening for type 2 diabetes.
  • If you are under age 40 to 45, but overweight with high blood pressure, low HDL (“good”) cholesterol, or high triglycerides you may need testing.
  • Get tested if you have a family history of diabetes or gave birth to a baby weighing > 9 lbs, diabetes in pregnancy (gestational diabetes), or a history of polycystic ovarian syndrome.
  • Black, Hispanic, Pacific Islander, Asian, or American Indian ancestries may need to be tested. These ethnic groups may be at increased risk for diabetes at a younger age or at a lower body mass index.
  • Retesting is recommended every 3 years if your blood sugar is normal, but your doctor may decide more frequent testing is needed.

If your blood sugar is high upon screening, your doctor should refer you to an intensive program that can help you lose weight, eat a healthy diet, and get exercise.

If you take regular doses of glucocorticoids, like prednisone, or antipsychotics, such as Abilify (aripiprazole), you may need to have your blood sugar tested, too.

What are the Symptoms of Prediabetes or Diabetes?

Here's the problem: not all people with prediabetes have recognizable symptoms. In fact, type 2 diabetes usually develops slowly over time due to weight gain and other modifiable risk factors.

Roughly 84 million American adult -- more than 1 out of 3 -- have prediabetes, according to the CDC. What's worse - over 90% of Americans with prediabetes don't know they have it. Most people with prediabetes will develop type 2 diabetes within 10 years or sooner if preventive action is not taken.

Symptoms of diabetes may include:

  • Excessive thirst
  • Frequent urination
  • Blurred vision
  • Extreme fatigue
  • Frequent infections
  • Slow healing cuts or bruises
  • Numbness in hands and feet
  • Darkened skin areas

How is Prediabetes and Diabetes Diagnosed?

There are several tests that can be used to diagnose early diabetes or diabetes.

You may need to return to your doctor's office for more than one visit to have tests repeated to confirm a diagnosis. However, a high fasting blood glucose combined with a history of symptoms may be all that your doctor needs to diagnose diabetes.

Some of these tests may require that you have not had anything to eat for 12 hours (fasting) and only water to drink, so check with your doctor before you have blood tests completed.

The good news is early diabetes is reversible if you take action to lose some weight, eat healthy, and exercise.

What Tests Are Used to Diagnose Diabetes?

The following lab tests and values are often used to diagnose type 2 diabetes:

  • A1C: The A1C test measures your average blood glucose over the past 2 to 3 months; results greater than 6.5% usually result in a diagnosis of diabetes.
  • Fasting Plasma Glucose (FPG): Diabetes is diagnosed with values greater than or equal to 126 mg/deciliter (dL).
  • Oral Glucose Tolerance Test (OGTT): Your blood sugar levels are checked before and 2 hours after you consume a sweet drink; a positive result is over 200 mg/dL.
  • Random Plasma Glucose Test: Diabetes is diagnosed with glucose greater than 200 mg/dL.

In 2018, the A1C target results came under controversial fire. For most adults, the American Diabetes Association (ADA) has recommended a target A1C of below 7%, which can be altered based on individual circumstances. But in March 2018, the American College of Physicians (ACP) relaxed these targets.

The new ACP guidance suggests that A1C should be between 7% and 8% for most adults with type 2 diabetes. For adults who achieve an A1C below 6.5 percent, the group suggests stepping down diabetes treatment to keep that level from going even lower. ACP also recommends to avoid a target A1C level in diabetes patients over 80 years, who live in a nursing home or, with chronic health conditions. Instead, ACP recommends minimizing symptoms of high blood sugar for these patients.

However, the ADA said the new guidance may cause potential harm to those who may safely benefit from lowering A1C targets. The take-away message? Your A1C goals should be personalized for you by your doctor, based on your risk factors, history, and personal preferences.

How Do I Know If I Have Prediabetes?

Seeing your doctor if you have risk factors for diabetes and having a blood test done is key to diagnosing prediabetes. The tests used to diagnose prediabetes are the same as the ones used to diagnose diabetes, but your blood sugar results are lower.

Test results that may guide your doctor to a diagnosis of prediabetes include:

  • A hemoglobin A1C test of 5.7% to 6.4%
  • A fasting blood glucose of 100 to 125 mg/deciliter (dL)
  • An oral glucose tolerance test (OGTT) 2 hour blood glucose of 140 mg/dL to 199 mg/dL

Catching elevated blood sugars in the prediabetes phase may allow you to make lifestyle and diet changes and avoid drug treatment altogether.

My Tests Show I Have Prediabetes - What Now?

Prediabetes should be a wake-up call for a healthier routine.

You can reduce your risk of developing diabetes through:

  • lifestyle changes, including eating a healthy diet
  • losing weight
  • regular moderate exercise can reduce insulin resistance, even if you don't lose weight.
  • consulting with your doctor, a diabetes specialist and possibly even a dietician who can help guide you through these changes.

Research shows that you can cut your risk for type 2 diabetes in half by meeting these two goals:

  • Losing about 5% to 7% of your body weight (10 to 14 pounds if you weigh 200 pounds).
  • Moderate exercise (such as brisk walking, swimming or bicycling) 30 minutes a day, for 5 to 6 days per week.

Is There a Treatment for Prediabetes?

Initial treatments for diabetes, such as sulfonylureas or insulin are not usually started at this point; however, metformin has been used successfully in prediabetes to help lower blood sugars.

Lifestyle changes, weight loss and healthy eating is usually your first approach. If you have been diagnosed with prediabetes, eating healthy foods that are low in fat and calories, and increasing your intake of high fiber foods may help you lower blood sugar and keep it from progressing to type 2 diabetes.

Moderately active exercise 30 to 60 minutes a day, most days of the week is important, too. Even a brisk, one mile walk is helpful. Losing just 10 to 20 pounds if you weigh 200 pounds can reduce your risk of developing type 2 diabetes.

What are the Complications from Having Prediabetes or Diabetes?

Diabetes complications due to high blood sugar can lead to damage in your nerves, and result in harm to small and large vessels in your body.

Long-term and potentially life-threatening complications may occur such as:

  • Heart disease and stroke
  • High blood pressure
  • Blindness due to diabetic retinopathy in the eye(s)
  • Kidney disease requiring dialysis or transplant
  • Nervous system damage (neuropathy)
  • Lower-limb amputations

What is the Cost Impact of Diabetes in the U.S. Healthcare System?

The cost of type 2 diabetes in the U.S. healthcare system is staggering, and probably will continue to grow. Economic costs of diabetes increased by 26% from 2012 through 2017.

The total cost of diabetes care in 2017, the most recent data from the ADA, was close to $327 billion, with roughly $237 billion in direct medical costs and $90 billion in lost productivity costs such as disability, work loss, or premature death attributed to diabetes.

In addition, the average medical expenditures among people with diabetes were 2.3 times higher than in those without diabetes. In those who have a diagnosis of diabetes, their average medical expenses were $16,750 per year, of which roughly $9,600 was attributed to diabetes.

One in four health care dollars is spent caring for people diagnosed with diabetes. However, the overall costs of undiagnosed diabetes might even be greater. Only after a diagnosis of prediabetes or diabetes can a patient realize the urgency to take action to change their lifestyle and prevent complications.

If you would like to stay up-to date with news and new drug approvals for type 2 diabetes, and have a chat with others who have your same concerns, consider joining the Drugs.com Type 2 Diabetes Support Group and the Questions Group.

Finished: Prediabetes - Am I At Risk?

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Sources

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  • U.S. Department of Health and Human Services. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Diabetes Education Program. What is Diabetes? Accessed March 24, 2018 at https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes
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Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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