Prediabetes diagnosis

[Angelofthemarches]

Hi all
So was diagnosed type 2 7 years ago. Since then I have kept my hba1c under 42, often under 40. I now take 2*500mg Metformin a day but was thinking of reducing.
I'm a bit puzzled about the criteria for prediabetes diagnosis. Some say under 42 (mmol/mil??) and some say under 100mg/dl.
If it's the latter I don't seem to stand much chance of getting out of the prediabetic range.
Usually I'm a daily average of 6.5mmol/l - 6.8.
I have dawn phenomenon so 5.7 mmol/l to 6.3.
Advice please

 

[ajbod]

Technically pre diabetes is not an actual condition, it means you are in the range likely to develop diabetes. In the UK the range is set at 42 - 47 Hba1c. 48 being the start of diabetes. as long as you're below the 42 Hba1c, then you're rocking it. Only an actual Hba1c test, will be accurate enough to know where you are. Most estimated by libre etc are not always very close to the Hba1c. Your fasting level often gives no comparison to your Hba1c, as it can be quite a bit higher than the rest of the days readings.

 

[ianf0ster]

In the USA and some other countries the range they use for pre-diabetes starts a bit lower when converted to the units used here in the UK. The level at which Diabetes starts is however agreed internationally among those countries using the HbA1C test to determine it.

 

[Angelofthemarches]

Actually so far my hba1c and the libre estimate have been pretty close over the last 7 years

 

[stuffedolive]

you say you are on Metformin? were you prescribed this as a prediabetic? or, were you in the diabetic range (ie Hba1c > 48) and the Metformin is now keeping you in the prediabetic range?

 

[KennyA]

Hi all
So was diagnosed type 2 7 years ago. Since then I have kept my hba1c under 42, often under 40. I now take 2*500mg Metformin a day but was thinking of reducing.
I'm a bit puzzled about the criteria for prediabetes diagnosis. Some say under 42 (mmol/mil??) and some say under 100mg/dl.
If it's the latter I don't seem to stand much chance of getting out of the prediabetic range.
Usually I'm a daily average of 6.5mmol/l - 6.8.
I have dawn phenomenon so 5.7 mmol/l to 6.3.
Advice please

42mmol/mol is equivalent to 126 mg/dl.

100 mg/dl is equivalent to an HbA1c of 32 mmol/mol. I don't know ehere you read that but I think that the source might be mistaken. I'm attaching a graph that shows the distribution of HbA1c results in a non-diabetic population. You'll just about everyone is well above 32mmol/mol.

 

[Angelofthemarches]

I was prescribed Metformin once diagnosed diabetic 7-8 years ago. Initial hba1c 62. Usual hba1cs since 39-41.
Not sure I even need the Metformin a lot

 

[Angelofthemarches]

Interesting!

 

[stuffedolive]

I was prescribed Metformin once diagnosed diabetic 7-8 years ago. Initial hba1c 62. Usual hba1cs since 39-41.
Not sure I even need the Metformin a lot

Replying to your original question about the range for pre-diabetes (T2). My understanding is that if your Hba1c is 42-48 (without medication) then you are considered to be in the pre-diabetic range , above 48 is the diabetic range.
I was diagnosed T2 20years ago on the basis of my FBG and OGTT. Since then I have kept my Hba1c in the 42-48 pre-diabetic range through diet and exercise without any medication, apart from one reading of 50 when my GP wanted to put me on Metformin immediately - I refused and by reviewing my diet & exercise I got my Hba1c back in range. However, once T2, always T2, so its an ongoing battle for me to stay off meds.

If you think you could come off Metformin, then you need to talk to your GP. Good luck.

 

[elfan]

I too have been 10 years - diet and exercise - to keep off medication. Worth it though. Kept between 42 and 48.

 

[KennyA]

I was prescribed Metformin once diagnosed diabetic 7-8 years ago. Initial hba1c 62. Usual hba1cs since 39-41.
Not sure I even need the Metformin a lot

I have no personal experience of metformin, but the Handbook of Diabetes has this to say:

"Metformin increses insulin action (the exact mechanism is unclear), lowering glucose mainkly by decreasing hepatic glucose output. Unlike sulponylureas, it does not cause hypoglygaemia or weight gain and indeed, has some appetite suppressing activity that may encourage weight loss."

 

[tom1179]

Interesting!

Hi

You mentioned that you keep in the prediabetes range from 42 to 48 without meds is being in the prediabetes rang cause damage?

Interesting!

 

[KennyA]

Hi

You mentioned that you keep in the prediabetes range from 42 to 48 without meds is being in the prediabetes rang cause damage?

Short answer is that it can, just as some people can have much higher BG and have no symptoms whatsoever. I had a range of symptoms caused by high glucose levels long before I got to 48. However, despite the range and intensity of symptoms, I was firmly told I wasn't diabetic.

The numbers are just an agreement between medics world-wide as to what they will all accept as an automatic T2 diagnosis - largely because retinopathy is rare beneath 48mmol/mol. The current level for automatic T2 diagnosis was agreed around 2008.

It was supposed to be a backstop, but that didn't last long. The concept of "pre-diabetes" then had to be invented to cover the gap between normal BG range (38-42) and 48.