pre-diabetes word cloud

Progress in Diagnosing Pre-Diabetes

Professional organizations don’t agree on how to define pre-diabetes, a condition that indicates a patient is likely to develop type 2 diabetes and its potential complications in the near future. For example, the American Diabetes Association recommends using hemoglobin A1C or glucose levels to diagnose pre-diabetes, while the World Health Organization recommends physicians use glucose only.

But new research from Johns Hopkins suggests that defining pre-diabetes based on hemoglobin A1C, a common test that determines a long-term average blood sugar level, is the most accurate predictor of who will go on to develop long-term complications from diabetes.

What they do agree on, however, is that people who are at high risk of developing diabetes can reduce that risk substantially through lifestyle modifications such as moderate weight loss, increased exercise and diet modifications. Some groups also recommend the use of a medication called metformin to help reduce diabetes risk. The issue is figuring out the best way to identify people with pre-diabetes, researchers say.

The findings, from researchers at the Johns Hopkins Bloomberg School of Public Health, were published in the Lancet Diabetes & Endocrinology.

“The goal is to figure out who is at the highest risk of not only developing diabetes but of developing its serious complications including kidney disease, cardiovascular disease and even death,” says study leader Bethany Warren, a PhD student in the Department of Epidemiology at the Bloomberg School. “Hemoglobin A1C appears to be the tool that is best able to do that.”

Another set of criteria used to define pre-diabetes uses a fasting glucose test (taken after the patient hasn’t eaten for eight hours) or a two-hour glucose test, which uses the fasting test while also checking the blood two hours again after consuming a sugary drink. The researchers found no difference between the two glucose measures, but did find that they identified more people as having pre-diabetes than hemoglobin A1C, even though fewer of them would go on to develop complications from diabetes. Glucose measures look at current levels in the blood as opposed to hemoglobin A1C, which looks at a longer-term average of glucose exposure over the prior two to three months.