Prediabetes, also commonly referred to as borderline diabetes, is a metabolic condition and growing global problem that is closely tied to

obesity.

If undiagnosed or untreated, prediabetes can develop into type 2 diabetes; which whilst treatable is currently not fully reversible.

What
is prediabetes?

Prediabetes is characterised by the presence of

blood glucose levels that are higher than normal
but not yet high enough to be classed as diabetes.

For this reason, prediabetes is often described as the “gray area” between normal blood sugar and diabetic levels. In the UK, around

7 million people are estimated to have prediabetes
and thus have a high risk for developing type 2 diabetes.


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Prediabetes may be referred to as

impaired fasting glucose (IFT), if you have higher than normal sugar levels after a period of fasting, or as

impaired glucose tolerance (IGT), if you have higher than normal sugar levels following eating.

The increasing number of new cases of prediabetes presents a global concern as it carries large scale implications towards the future burden on healthcare. Between 2003 and 2011, the prevalence of prediabetes in England alone more than tripled, with 35.3% of the adult population, or

1 in every 3 people

having prediabetes.


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Learn more about prediabetes

Prediabetes is a critical stage in the development of diabetes, for it is at this point that lifestyle choices can be made to turn it around. Early, decisive action can slow down or even halt the

development of type 2 diabetes

Explore Prediabetes

Diabetes Risk Factors

Tests for Pre-Diabetes

Metabolic Syndrome

Insulin Resistance

Glucose Intolerance

Diabetes and Ethnicity

Diabetes and Obesity

Waist Size Risk

Impaired Fasting Glycemia

Impaired Glucose Tolerance

What are the symptoms of prediabetes?

Many people have prediabetes but are completely unaware of it. This is because the condition often develops gradually without any warning signs or symptoms. In many cases, the sufferer only learns of their

borderline diabetic

state once the

symptoms of type 2 diabetes
start to appear. Therefore, being aware of the risk factors is essential.

What are the risk factors for prediabetes?

You should be tested for prediabetes if you:

• 
  Are overweight or obese
• 
  Have a close relative (parent or sibling) who currently has or has had diabetes
• 
  Have high blood pressure,
  
  low HDL (‘good’ cholesterol)
  or high triglycerides
• 
  Are over the age of 40
• 
  Have given birth to a baby who weighed over 9 pounds

While pre-diabetes may affect anyone, of any age, gender or racial type, some groups are genetically more prone. These include:

• Afro-Caribbean
• South Asian
• Native American

Testing for prediabetes

Either a

fasting plasma glucose test
or an

HbA1c test
may be used to diagnose type 2 diabetes or prediabetes.

The following results indicate the presence of prediabetes:

• 
  Fasting plasma glucose:
  
  5.5 mmol/L to 6.9 mmol/L
• 
  HbA1c:
  
  42 to 47 mmol/mol (6.0 to 6.4%)
  
  
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If your results are above the upper limits for prediabetes, your GP may either diagnose you with type 2 diabetes or take another test in the near future to confirm whether you have diabetes. If you have symptoms of diabetes but have an HbA1c of below 42 mmol/mol (6.0%), you may be given an

oral glucose tolerance test
(OGTT).

If you are diagnosed with prediabetes, your doctor should clearly set out the steps you need to take to lower your risk of developing type 2 diabetes.

Can I stop prediabetes developing into type
2 diabetes?

The good news is that cases of prediabetes that are identified early on can be reversed, preventing them from progressing into full-blown type 2 diabetes. Each year in the UK, 5% to 10% of people diagnosed with prediabetes go on to develop type 2 diabetes.

The two principle factors for consideration are:

• 
  Making changes to your diet
  and
• 
  Appropriate physical exercise to your lifestyle

By making these changes, blood sugar levels can be returned to normal.

In fact, the recently completed

Diabetes Prevention Program
study conclusively showed that people with borderline diabetes can prevent the development of type 2 diabetes by making dietary changes and increasing their level of physical activity.

For a comprehensive and individual plan, speak to your doctor.

Pre-diabetes will usually be diagnosed by a doctor using either an HbA1c or a fasting plasma glucose (FPG) test.
However, in some cases, an OGTT test may also be carried out.

Oral Glucose Tolerance Test (OGTT)

The OGTT is a screening test that involves testing the individual’s plasma glucose level following a glucose-rich drink (a beverage containing 75 grams of glucose).

An OGTT may be used in people that show symptoms of diabetes but have not recorded diabetic levels with the HbA1c or fasting plasma glucose tests.

The OGT test may be used for diagnosis, instead of the HbA1c in people with certain blood disorders such as shortened red blood cell life.

People who have impaired glucose tolerance (IGT) or pre-diabetes will have a plasma glucose level of

less than 11.0 mmol/L (200 mg/dl)

but

equal to or greater than 7.8 mmol/L (140 mg/dl)

• Read more about the
  
  Oral Glucose Tolerance Test

Those people who have a plasma glucose level over or

equal to 11.0 mmol/l (200 mg/dl)

after two hours will be asked to have a fasting plasma glucose test to confirm diabetes diagnosis.

The fasting plasma glucose test is used to diagnose diabetes, however.

Fasting Plasma Glucose Test (FGT)

The FGT test works by measuring the level of glucose in an individual’s blood after a period of fasting.

Anyone who is at a high risk of pre-diabetes should be given the FPG test. This includes those who are severely overweight or obese, people of South Asian or African-Caribbean descent, or anyone with a family history of diabetes.

The fasting plasma glucose test is performed after a person fasts for at least 8 hours.

Individuals who have a blood glucose level

greater than or equal to

7.0 mmol/L


(126 mg/dl) will be retested and
,

if the results are consistent
,

diagnosed with diabetes.

If the results are



less than 7.0 mmol/L



(126 mg/dl) but

greater than 6.1 mmol/L



(110 mg/dl) the individual will be diagnosed as having impaired fasting glucose, or pre-diabetes.

Pre-diabetes, if it goes undiagnosed, can lead to the development of

type 2 diabetes
These are the most common questions asked about pre-diabetes.

How is pre-diabetes different to type 2 diabetes?

Pre-diabetes occurs when blood glucose levels exceed normal levels but do not climb high enough to warrant a

diagnosis of diabetes

If pre-diabetes is left untreated it will quickly develop into type 2 diabetes, usually in less than ten years.

Is pre-diabetes the same thing as Impaired glucose tolerance or impaired fasting glucose?

Yes, although this depends on which test is used to diagnose the condition.

Is pre-diabetes the same thing as metabolic syndrome or syndrome X?

Pre-diabetes shares a number of factors with

metabolic syndrome
and syndrome x, and if unchecked can lead to type 2 diabetes.

Why is this condition called pre-diabetes?

Pre-diabetes used to be called IGT/IFG, but the term pre-diabetes makes it easier to understand.

Furthermore, pre-diabetes implies an impending risk that should be acted upon.

At the pre-diabetic stage type 2 diabetes can still be prevented or delayed.

How would I know if I have pre-diabetes?

The two types of tests for pre-diabetes can establish whether you are suffering from the condition. Doctors will typically use either the

fasting plasma glucose test
(FPG) or the

oral glucose tolerance test
(OGTT).

These tests require the patient to fast overnight.

What do you need to score on the FPG test to be diagnosed with pre-diabetes?

A normal fasting blood glucose level is below 100 mg/dl – between 100 and 125 mg/dl a person has pre-diabetes. If the blood glucose level rises to 126 mg/dl or above, a person has diabetes.

What do you need to score on the OGTT test to be diagnosed with pre-diabetes?

When it comes to the OGTT test, a person’s blood glucose is measured after a fast and 2 hours after a drink rich in glucose.

Normal levels are under 140 mg/dl 2 hours after the drink. 140 to 199 mg/dl 2 hours after the drink means that the person being tested has pre-diabetes. If the 2-hour blood glucose reaches 200 mg/dl or exceeds it, the person has

diabetes

Why is it essential to be diagnosed if I think I might have pre-diabetes?

It could be possible to prevent the development of

type 2 diabetes
if you find out about your pre-diabetes early enough.

Research indicates that people who have pre-diabetes can delay or prevent the onset of type 2 diabetes by almost 60 per cent with adjustments to diet and exercise.

Reducing weight by ten per cent, and partaking in modest physical activity for 30 minutes daily, could reduce the chance of developing type 2 diabetes.

Will insurance cover things like testing and treatment?

This depends on your insurance policy.

How is pre-diabetes treated?

To treat pre-diabetes, it is necessary to lose a modest amount of weight (approximately 5-10 per cent of total body weight.) This can be achieved through

diet
and modest

exercise
Any weight loss can make a huge difference. Having pre-diabetes increases the risk of

heart disease
or stroke.

Who should be tested for pre-diabetes?

Some people will be face an increased likelihood of having pre-diabetes. For instance, if you are overweight and aged 45 or older. Other risk factors can include high blood pressure, low HDL cholesterol, a family history of diabetes or gestational diabetes. Some ethnic groups are at a higher risk of diabetes.

When should I be tested?

You should be tested every three years, and if you have pre-diabetes you should be checked for type 2 diabetes at least annually.

Is it possible to have pre-diabetes and be unaware of it?

Yes. Some people who have pre-diabetes exhibit hardly any symptoms. Even diabetic people may not be aware of their condition.

Type 2 diabetes symptoms
include blurred vision, thirst, frequent need to pee, and tiredness.