What Is Prediabetes?

Illustration by Gloria Diianni

No doubt you’ve heard about America’s weight problem. More than 34% of US adults are overweight, and nearly 32% of children and adolescents are either overweight or obese, according to the National Institutes of Health.

All of those extra pounds are likely at least partly to blame for the increasing prevalence of prediabetes, which today affects one-third of American adults. In the Granite State alone, nearly 400,000 people have prediabetes; overall in the United States, 85 million people have it — but only 1 in 10 are aware that they have the condition, says Mehmet S. Marangoz, MD, an endocrinologist at Concord Hospital.

Prediabetes is often a precursor to type 2 diabetes. If you are diagnosed with prediabetes, you might be tempted not to take it seriously — it’s not full-blown diabetes, after all — but left untreated, it can significantly harm health and raise the risk of heart disease and stroke. Without intervention, it’s likely to progress to type 2 diabetes within 10 years.

Being diagnosed with prediabetes means your blood sugar is higher than normal, but not high enough to qualify as type 2 diabetes. In most cases of prediabetes, the body produces a normal amount of insulin — a hormone that manages blood sugar, or the amount of glucose in the bloodstream — but cells become resistant to insulin, causing glucose to accumulate in the bloodstream. Excess weight and body fat, and a sedentary lifestyle contribute to this process. The insulin-producing pancreas tries to keep up by churning out more insulin, but over time, Marangoz says, the pancreas can “burn out,” causing insulin levels to drop.

Most often, prediabetes produces no discernable symptoms, even as it harms blood vessels and heightens the risk of cardiovascular disease and stroke, and damages the eyes, kidneys, nerves and, at least in some cases, the brain. “We see that some patients start to have IQ issues,” says Marangoz. “They’re not as sharp as before.”

It’s not necessarily just about your cookie habit, though, or your addiction to soda. “There are a lot of misconceptions about diabetes,” says Kathryn Winslow, RN, BS, CDE, a certified diabetes educator at Southern New Hampshire Health System in Nashua. “A lot of people think ‘it’s just because I eat too much sugar,’ and that’s not true.” Many factors can contribute to diabetes risk. People with a family history of diabetes, for example, can be more susceptible to insulin resistance, Winslow says, “so they’re more likely to develop diabetes.”

Prediabetes is reversible with lifestyle changes, however. In particular, switching to a healthful diet and increasing physical activity to shed extra pounds will help ease insulin resistance. “Exercise actually helps the body to improve the insulin sensitivity, so the body uses insulin more effectively,” Winslow says. “All of us should be getting 150 minutes of physical activity” per week, she notes, regardless of whether we have blood sugar problems or not.

Landmark research in the 1990s made clear the significance of lifestyle choices in the development of diabetes and prompted the creation of the National Diabetes Prevention Program, led by the Centers for Disease Control and Prevention (CDC). In the study, participants who lost 5 to 7% of their body weight lowered their risk of developing type 2 diabetes by 58%.

Although maintaining a healthful weight is one of the key ways to minimize the risk of prediabetes and diabetes, it is best to avoid fad approaches to weight loss, such as the ketogenic and paleo diets, Marangoz warns. Instead, focus on shunning high glycemic index foods, which cause blood sugar to spike. That means taking a pass on processed foods such as white bread, most commercial breakfast cereals and pastries. Opt for lean proteins, whole grains and fruits and vegetables — and exercise a minimum of 30 minutes, five days per week. Those 30 minutes need not include sprinting or heavy-duty weight lifting, Marangoz says. Just daily walking will reduce your risk. Consult with your doctor to determine the diet and exercise plan most appropriate for you.

Your choices, your health
Many factors increase a person’s odds of developing prediabetes. Having a first-degree relative with type 2 diabetes raises your risk, as does being older than 45 and having a sedentary lifestyle. Certain races and ethnic groups face higher risk. But most often, obesity is to blame, says Mehmet S. Marangoz, MD, an endocrinologist at Concord Hospital. Because our weight and level of physical activity are largely within our control, prediabetes is considered reversible and avoidable.

Want more information?

• See tips from The American Diabetes Association on how to prevent or delay type 2 diabetes: main.diabetes.org/dorg/PDFs/what-is-prediabetes.pdf.
• Take a quiz to gauge your risk of prediabetes: cdc.gov/prediabetes/takethetest.
• If you are diagnosed with prediabetes and prefer a guided approach to getting your blood sugar back on track rather than going it alone, consider signing up for the CDC’s National Diabetes Prevention Program (National DPP) (cdc.gov/diabetes/prevention/about.htm), offered at hospitals and other locations around the state (nccd.cdc.gov/DDT_DPRP/CitiesList.aspx?STATE=NH). The National DPP is designed to help people make lasting changes for a healthful lifestyle that lowers diabetes risk. According to the CDC, through the program you can lower your chance of developing type 2 diabetes by as much as 58%, or 71% if you’re over the age of 60.