Nearly 24 million American adults are living with diabetes, according to figures released last month by the International Diabetes Federation. But what may be even more alarming is that there are also about 79 million Americans with a condition known as prediabetes — and many aren't aware of it.
Prediabetes means that while your blood sugar levels are higher than normal, that level isn’t high enough to warrant a diabetes diagnosis. However, a prediabetes diagnosis means it is time for action to prevent diabetes.
"In simple terms, there is a gap between what we call diabetes, which is a fasting blood sugar of 126 and above, and normal, which is less than 100 fasting," explains Vivian Fonseca, MD, a professor of medicine and pharmacology and chief of endocrinology at Tulane University Health Sciences Center in New Orleans. "In between, you have impaired fasting glucose. If you do a glucose tolerance test, and you are in the gap, you have prediabetes. You are at risk for getting diabetes in the future and you are also at risk for heart disease."
Research has also found that prediabetes may be more common in men than in women.
Type 2 Diabetes: Prevention
If you are told your blood sugar is abnormally high, you’ve just had a red flag waved in front of you. You’re being warned that unless you make some changes in your life today, your future will probably include a diabetes diagnosis.
"Walking 30 minutes a day and reducing weight by 5 percent can decrease the risk [of getting type 2 diabetes] by 60 percent over three years," says Dr. Fonseca. While there are medications that have the same effect, lifestyle change is less expensive and has fewer side effects, Fonseca says.
Cutting your weight is crucial. "One of the links with obesity is that fat induces a mild low-grade inflammation throughout the body that contributes to heart disease and diabetes," Fonseca explains. Without making any changes, you could developtype 2 diabetes within 10 years of first developing prediabetes.
Type 2 Diabetes: Who Should be Tested?
Prediabetes is a "silent" condition, says Fonseca. While some people may experience symptoms of diabetes such as fatigue or increased urination, most people’s blood sugar rises without any outward signs at all. This means you might not know you need to be tested for prediabetes — and even if you are screened, your doctor might not give you all the information you need to prevent it.
For these reasons, diabetes experts developed criteria for those who should be tested. The American Diabetic Association recommends that any adult age 45 or older should be tested for diabetes and prediabetes.
The ADA also recommends that any adult under age 45 who is overweight and has at least one of the following risk factors should be tested:
  • Family history (especially parent or sibling with diabetes)
  • Physically inactive lifestyle
  • Native American, African-American, or Hispanic heritage
  • Prior gestational diabetes diagnosis
  • Birth of a baby over nine pounds in weight
  • High blood pressure or treatment for high blood pressure
  • Polycystic ovarian syndrome (PCOS) diagnosis
  • Dark, velvety rash around the armpits or neck
  • History of heart disease
If your test reveals that you have prediabetes, you should be tested again in one to two years, depending on your doctor’s recommendations.
Type 2 Diabetes: Types of Tests
There are two tests used to screen for diabetes and prediabetes:
  • Fasting plasma glucose: a test of your blood after you haven’t eaten for eight hours (usually overnight)
  • Oral glucose tolerance test: a comparison of your blood taken first after eight hours without food (fasting) and then two hours later after you have consumed a sugary drink given to you by the lab technician.
If you fit the screening criteria listed above, make an appointment to get tested as soon as possible. It could be the first step toward preventing the development of type 2 diabetes.