Well Being Magazine

Prediabetes: Are you at risk?

Prediabetes: Are you at risk?

The Centers for Disease Control and Prevention estimate that 79 million, or 35 percent of adults in the U.S. over the age of 20, have prediabetes. It is believed that only about 7 percent know they have the condition. Are you one of them?

A Wakeup Call

Prediabetes is an early warning that cells in the body are failing to respond effectively to insulin and are not absorbing sugar from the blood. Consider it a wakeup call that you could be on the path to developing diabetes. The first thing you should know about prediabetes is that it is reversible and does not have to lead to full-blown diabetes. The second thing you should know about prediabetes is that you have the power to reverse it by incorporating some significant dietary and lifestyle changes into your life.

Well-Being spoke to J. Kevin Bridges, M.D., Internal Medicine physician at Merit Health Medical Group Internal Medicine in Madison, about what prediabetes is and what a person with the diagnosis of the condition should know.

“Prediabetes is a fairly new way to describe what physicians have called Impaired Fasting Glucose (IFG) or Impaired Glucose Tolerance (IGT) in the past,” explains Dr. Bridges. “Another way it has been defined in lay terms is borderline diabetes. Basically, it is a term that is used to define changes in metabolic processes that happen in your body leading to an increase in blood glucose levels that are above what is considered to be normal, but not quite as high as a diabetic’s glucose levels. Prediabetes is an abnormal phase between normal and diabetes.”

About 15-30% of people with prediabetes go on to develop type 2 diabetes.

How is Prediabetes Diagnosed

Dr. Bridges continues, “In general, we use three different ways to screen for diabetes or prediabetes. We generally like to check fasting (pre-meal) plasma glucose (FPG). Normal is considered to be less than 100. Prediabetes is considered to be 100-125. Diabetes is considered to be equal to or greater than 126.”

“Another test used is a hemoglobin A1c,” Bridges adds. “This is also a blood test. Normal is less than 5.7%, prediabetes is 5.7% – 6.4%, and diabetes is equal to or greater than 6.5%.”

According to Dr. Bridges, an oral glucose tolerance test (OGTT) also is used to determine if someone has prediabetes or diabetes. For this test a person drinks a glucose drink and then their blood sugar is checked 2 hours later. Normal is less than 140. Prediabetes is 140-199. Diabetes is diagnosed when the level is above 200. A random glucose of 140 – 199 suggests someone is at high risk for diabetes or prediabetes and should warrant further testing/follow up. A random glucose of greater than 200 suggests a diagnosis of diabetes and certainly warrants follow up.

Risk Factors for Prediabetes

There are a number of factors that can put a person at a higher risk of developing prediabetes, and the possibility that the condition could eventually progress to become type 2 diabetes. Some of these factors we can control, some we cannot, but knowing what they are can make us more aware of our potential risks.

• Weight: People who are heavier – especially heavier around the midsection or waist – tend to have a higher risk for prediabetes. One simple way of determining this is to measure the waist (in inches). The risk of prediabetes is increased in women with a waist measurement of > 35 inches and in men with a waist measurement of > 40 inches.
• Physical Inactivity: People who tend to do little physical activity tend to be heavier and this has long been thought to be an indirect way that low levels of physical activity put a person at risk for prediabetes. But, since exercise has been shown to reduce inflammation and since inflammation is always a part of prediabetes, the lack of physical activity may increase the risk of prediabetes more directly by increasing the amount of inflammation in the body.
• Genetics or Family History: Your heredity can be very important as a risk factor. If a close family member had or has prediabetes or diabetes, you have a greater risk of prediabetes yourself.
• Ethnic Background: People of African, Hispanic, North American Native and Asian backgrounds have a higher risk of prediabetes.
• Age: After the age of 45, your risk of prediabetes begins to increase. After the age of 65, the risk starts increasing more dramatically.
• Medical History: Your personal medical history can increase your risk of prediabetes. For example, if you have a history of high blood pressure, high levels of LDL-cholesterol (or low levels of HDL-Cholesterol), a history of polycystic ovary syndrome (PCOS) or have had gestational diabetes, your risk of prediabetes is increased.

Treatment for Prediabetes

A diagnosis of prediabetes doesn’t necessarily come with a prescription medication. The most common treatment is instead a prescription for lifestyle changes and improved dietary decisions.

“Most people really don’t understand that this is a diagnosis in which they can actually determine whether this is reversed or not, simply by making the right lifestyle choices,” notes Dr. Bridges. “If a person with prediabetes will make a commitment to lose weight by eating healthier and exercising regularly, they may be able to reverse prediabetes without any other treatment.”

It is also very important that a patient with prediabetes see their primary care physician on a more frequent basis.

“When a patient has prediabetes, we check the test that I referred to earlier (A1c), every 3 or 4 months to see if they have improved, stayed the same, or gotten worse. In the beginning, I think patients should make their first few follow up appointments no less frequent than every 3 or 4 months to see if the changes they are making are actually making a difference. They also need to know if they are getting worse, despite all of their efforts, so that treatment can be intensified if necessary,” Bridges adds.

A person with prediabetes should also test their blood sugar regularly themselves. Dr. Bridges recommends that it become a normal part of their routine. “In order to reverse this process, or prevent it from progressing, one should take an active role in seeing where they stand on a daily basis by routinely checking their blood sugar.”

The Take-Away

The most important thing to take away from this overview of prediabetes is that you have the potential to reverse it before it ever becomes full-blown type 2 diabetes. If you have any questions about why that is important, you need to be keenly aware of the serious risks diabetes poses to your overall health. Left untreated diabetes can cause blindness, kidney damage and potentially kidney failure, heart attack, stroke, nerve damage and the potential for amputations of extremities. Considering all of this, working with your primary care physician to develop a plan of action and making common sense lifestyle and dietary changes seem well worth the effort.

J. Kevin Bridges, M.D., Internal Medicine, of Merit Health Medical Group Internal Medicine in Madison, received his Doctor of Medicine degree from the University of Mississippi School of Medicine and served his residency at University of MS Medical Center. Dr. Bridges specializes in treating adults for everything from minor emergencies to chronic disease management and preventive care. He is Board Certified in Internal Medicine.