What is Prediabetes and Why Does It Matter?

When I’m seeing a new patient, I am especially alert to certain pieces of their history. Do they have a strong family history of diabetes? Are they of Latino, Asian, Native-American, or African-American ethnicity? Did they have diabetes in pregnancy? Are they overweight or obese? Do they have polycystic ovarian syndrome (PCOS)?

Why do I care about these things? Because they may be clues that the patient is at risk for developing adult-onset (type 2) diabetes, and that can lead to multiple major medical problems.

Many people have heard of type 2 diabetes, a disease where the body loses its ability to manage sugar levels. Adult-onset diabetes most often affects people with known risk factors and can take years to fully develop, unlike juvenile (type 1) diabetes, which can develop randomly and quickly.

Here is why high blood sugar is a problem

Untreated or undertreated diabetes means persistently high blood sugars, which can cause horrible arterial blockages, resulting in strokes and heart attacks. High blood sugars also cause nerve damage, with burning leg pain that eventually gives way to numbness. This, combined with the arterial blockages, can result in deformities and dead tissue, which is why many people with diabetes end up with amputations. The tiny blood vessels to the retina are also affected, which can cause blindness. And don’t forget the kidneys, which are especially susceptible to the damage caused by high blood sugar. Diabetes is a leading cause of kidney failure requiring dialysis and/or kidney transplant. But wait! There’s more. High blood sugar impairs the white blood cell function critical to a healthy immune system, and sugar is a great source of energy for invading bacteria and fungi. These factors put folks at risk of nasty infections of all kinds.

These facts scare me. Not just because I’m the doctor who gets to help manage these not-fun issues, but because I’m of Latina descent and diabetes runs in my own family. I’m at risk too.

So, what can we do? If we know who is at risk for diabetes, and it takes years to develop, we should be able to prevent it, right? Right!

Keeping prediabetes from becoming diabetes

A recent in-depth article by endocrine experts declares prediabetes a worldwide epidemic (which it is).1 Prediabetes is defined by fasting blood sugars between 100 and 125, or an abnormal result on an oral glucose tolerance test. What can we do to treat prediabetes? The authors reviewed multiple large, well-conducted studies, and all showed that prediabetes can be targeted and diabetes delayed or prevented.

One of the largest studies was conducted here in the U.S.2 Over 3,000 people from 27 centers who were overweight or obese and had prediabetes were randomly assigned to one of three groups:

  1. standard lifestyle recommendations plus the medication metformin (Glucophage);
  2. standard lifestyle recommendations plus a placebo pill;
  3. an intensive program of lifestyle modification.