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April 2009 - Pre-Diabetes
While many people know about diabetes and the seriousness of the disease, they may be less familiar with a condition called pre-diabetes. Before people develop type 2 diabetes, they almost always have pre-diabetes.
In diabetes, the body does not produce or properly use insulin, a hormone made by the pancreas. The body uses insulin to maintain normal blood glucose levels (glucose is the main sugar the body makes from food). Insulin converts sugar, starches and other food into energy the body uses every day. There are two main types of diabetes:
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- In type 1 diabetes, which affects about 10 percent of Americans diagnosed with diabetes, the body is unable to produce insulin.
- In type 2 diabetes, the cells of the body are resistant to insulin, primarily because of obesity. The pancreas produces more insulin, but it is not enough to overcome the resistance, resulting in elevated blood sugar levels.
In addition, gestational diabetes affects about 4 percent of pregnant women who have never had diabetes before but who have high blood sugar levels during pregnancy.
According to the American Diabetes Association, an estimated 57 million people in the United States have pre-diabetes, in addition to the 23.6 million with diabetes.
“Pre-diabetes is a condition that occurs when a person’s blood glucose levels are higher than normal but not high enough for a diagnosis of type 2 diabetes,” said Bradley Javorsky, MD, Medical College of Wisconsin endocrinologist at the Froedtert & The Medical College of Wisconsin Endocrinology Center.
“We care about pre-diabetes because people with it have an increased risk of developing cardiovascular disease and a much higher risk of developing diabetes. If a person with pre-diabetes does nothing to lower their blood glucose level, they have a much higher risk of developing diabetes within five to 10 years. Once that happens, it sets into motion a lifetime of living with and managing the disease.”
The symptoms of diabetes include frequent urination, excessive thirst, extreme hunger, unusual weight loss, fatigue, irritability and blurry vision. People who have pre-diabetes, however, usually don’t have symptoms.
“To determine if a patient has pre-diabetes or diabetes, we measure a fasting plasma glucose (FPG) or perform an oral glucose tolerance test (OGTT),” Dr. Javorsky said.
With the FPG test, a fasting blood glucose level between 100 and 125 mg/dl signals pre-diabetes. A person with a fasting blood glucose level of 126 mg/dl (Mg/dl = milligrams per deciliter (one-tenth of a liter)) or higher has diabetes.
In the OGTT test, a person’s blood glucose level is measured after a fast and two hours after drinking a glucose-rich beverage. If the two-hour blood glucose level is between 140 and 199 mg/dl, the person has pre-diabetes. If the two-hour blood glucose level is at 200 mg/dl or higher, the person has diabetes.
“We’re increasing our understanding of the risk of blood sugar levels to health down the road,” Dr. Javorsky said. “We know that we can prevent diabetes by effectively managing pre-diabetes. Clinical trials in the last 10 years show that lifestyle changes and medication can significantly reduce the risk of developing type 2 diabetes among those with pre-diabetes. A 5 percent to 7 percent reduction in weight can lower the risk by 60 percent, and medications can lower the risk by 30 percent.”
The American Diabetes Association’s guidelines for the prevention/delay of type 2 diabetes are:
- Patients with impaired glucose tolerance (IGT) or impaired fasting glucose (IFG) should be referred to an effective ongoing support program for weight loss of 5 percent to 10 percent of body weight and increasing physical activity to at least 150 minutes per week of moderate activity such as walking.
- Follow-up counseling appears to be important for success.
- In addition to lifestyle counseling, metformin may be considered in those who are at very high risk for developing diabetes and who are obese and under 60 years of age.
- Monitoring for the development of diabetes in those with pre-diabetes should be performed every year.
The American Diabetes Association has identified several testing guidelines for pre-diabetes. Dr. Javorsky recommends talking to your primary care physician about your personal risk for pre-diabetes and diabetes and if your blood glucose level should be tested.
ResourcesSmall Stones, a health resource center of Froedtert & The Medical College of Wisconsin, offers the following resources pre-diabetes and diabetes:
Prediabetes Wake-Up Call by Beth Ann Petro Roybal, MA
Prediabetes - What You Need to Know to Keep Diabetes Away by Gretchen Becker
Know Your Numbers, Outlive Your Diabetes – 5 Essential Health Factors You Can Master to Enjoy a Long and Healthy Life by Richard Jackson, MD, and Amy Tenderich
Type 2 Diabetes the First Year – An Essential Guide for the Newly Diagnosed by Gretchen Becker
The Type 2 Diabetes Sourcebook by David Drum and Terry Zierenberg, RN, CDE
American Medical Association Guide to Living with Diabetes
What to Eat if You Have Diabetes by Maureen Keane, MS, and Daniella Chace, MS
Fix It and Enjoy It Diabetic Cookbook by Phyllis Pellman Good with the American Diabetes Association
Mix n’ Match Meals in Minutes for People with Diabetes by Linda Gassenheimer with the American Diabetes Association
Exercises for Diabetes by Erin O’Driscoll, RN, MA
A Meditation to Help You Control Diabetes by Belleruth Naparstek
Testing GuidelinesThe American Diabetes Association (ADA) offers the following guidelines for testing for pre-diabetes and diabetes in patients without symptoms:
- Testing to detect pre-diabetes and type 2 diabetes in asymptomatic people should be considered in adults of any age who are overweight or obese (BMI ≥25 kg/m2) and who have one or more additional risk factors for diabetes). In those without these risk factors, testing should begin at age 45 years.
- If tests are normal, repeat testing should be carried out at least at three-year intervals.
- To test for pre-diabetes or diabetes, an FPG test or 2 hour OGTT (75-g glucose load) or both are appropriate.
- An OGTT may be considered in patients with impaired fasting glucose (IFG) to better define the risk of diabetes.
- In those identified with pre-diabetes, identify and, if appropriate, treat other cardiovascular disease (CVD) risk factors.
The ADA offers the following criteria for testing for pre-diabetes and diabetes in asymptomatic adult individuals:
Testing should be considered in all adults who are overweight or obese (BMI ≥25 kg/m2) and have additional risk factors:
- Physical inactivity
- First-degree relative with diabetes
- Members of a high-risk ethnic population (e.g., African-American, Latino, Native American, Asian American, Pacific Islander)
- Women who delivered a baby weighing 9 lbs or were diagnosed with gestational diabetes mellitus
- Hypertension or high blood pressure (140/90 mmHg or on therapy for hypertension)
- HDL cholesterol level 35 mg/dl and/or a triglyceride level 250 mg/dl
- Women with polycystic ovarian syndrome (PCOS)
- IGT or IFG on previous testing
- Other clinical conditions associated with insulin resistance, such as severe obesity or acanthosis nigricans (a dark discoloration of the skin related to obesity and high levels of insulin in the blood)
- History of cardiovascular disease
In the absence of the above criteria, testing for pre-diabetes and diabetes should begin at age 45 years. If results are normal, testing should be repeated at least at 3-year intervals, with consideration of more frequent testing
Author: Marla Fraunfelder | Medical Reviewer: | Bradley Javorsky, MD | | Medical College of Wisconsin endocrinologist |
Last Review Date: April 1, 2009 Online Editor(s): Christopher Sadler
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