Person preparing to collect finger prick blood sample to check for prediabetes

What is prediabetes?

Written on December 13, 2022 by Theresa Vuskovich, DMD. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.

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Did you know 1 in 3 Americans has prediabetes [1]? You may not even realize you have prediabetes, which is characterized by high blood sugar levels, but not high enough to qualify for type 2 diabetes [2]. When you have prediabetes, you can develop type 2 diabetes, which can cause nerve problems, kidney problems, and heart disease [2]. This article will discuss prediabetes, how to recognize prediabetes, and how to prevent the progression of prediabetes to type 2 diabetes.

How do you know if you have prediabetes?

You can determine whether you have prediabetes by checking your blood sugar levels through a blood test such as an A1C test, fasting plasma glucose (FPG) test, or glucose tolerance test (GTT) [4]. There are no obvious symptoms of prediabetes, so it often goes undetected. The only way to know if you have prediabetes is to consult with a healthcare provider.

The Centers for Disease Control and Prevention (CDC) and the American Diabetes Association (ADA) offer a prediabetes screening test to determine your risk for diabetes [3,4]. You are more likely to receive a prediabetes diagnosis if you answer yes to five of the following questions [3,4]:

  • Are you older than 40 years old?
  • Do you belong to the male sex?
  • Did you develop diabetes during pregnancy (gestational diabetes)?
  • Does a family member have diabetes?
  • Do you have high blood pressure (hypertension)?
  • Are you physically inactive?
  • Is your body mass index (BMI) above 25?

The ADA now recommends screening everyone 35 years and older for prediabetes due to the rising rate of prediabetes and the lack of obvious prediabetes symptoms [4,5]. Prediabetes can cause the following symptoms [5]:

  • Eating more than usual
  • Gaining or losing weight without explanation
  • Being overweight or obese
  • Feeling weak
  • Feeling fatigued
  • Sweating excessively
  • Having vision problems
  • Experiencing slow healing of cuts or bruises
  • Having recurrent skin infections
  • Experiencing excessive gum bleeding

If you are at risk of prediabetes based on the risk assessment test and are experiencing any of the symptoms listed above, then you may have prediabetes. However, you must visit your healthcare provider to receive a prediabetes diagnosis.

How is prediabetes diagnosed?

Your healthcare provider will diagnose you with prediabetes through a series of blood tests, which are the same tests used to diagnose type 2 diabetes [4]. It is important to recognize that prediabetes is not a specific disease but rather a risk factor for developing type 2 diabetes and heart disease in the future [4]. Essentially, it is your body's way of telling you to change your lifestyle to prevent type 2 diabetes, which is more difficult to reverse than prediabetes [4]. Your healthcare provider may order the following diabetes blood tests to diagnose prediabetes [4-7]:

  • Fasting Blood Glucose Test (FBG): The FBG measures how much sugar is in your blood after not eating for 8-12 hours (i.e., fasting). After fasting, you'll visit your healthcare provider's office for the FBG test. A fasting blood sugar level between 100 and 125 mg/dL indicates prediabetes. This means that your blood sugar levels are higher than normal but too low to qualify as diabetes.
  • Glucose Tolerance Test (GTT): The GTT measures how efficiently your body moves sugar from the blood into tissues. You are instructed to fast overnight prior to the test and have your blood drawn the next day after drinking a glucose-containing liquid. After drinking the liquid, your blood sugar level will be checked every hour for up to 3 hours. Blood sugar levels below 140 mg/dL are considered normal, 140 to 199 mg/dL indicate prediabetes, and 200 mg/dL or higher indicates diabetes.
  • A1C Test: This test is also known as the HbA1c test. The A1C test evaluates the percentage of your red blood cells attached to a sugar molecule. This measures your average blood sugar levels over the previous two to three months. A1C levels between 5.7% to 6.4% indicate prediabetes. Healthcare providers use the A1C test to determine how well you are responding to your current diet, exercise, and medication regimen.

Your healthcare provider will determine if you have prediabetes based on your blood test results and a physical examination [6]. The ADA and other health organizations, such as the World Health Organization (WHO), have different criteria for diagnosing prediabetes [8]. Your diagnosis of prediabetes will depend on which guidelines your healthcare provider follows [8]. Detecting prediabetes early is essential for preventing the progression of prediabetes to type 2 diabetes.

Type 2 diabetes occurs when your body cannot produce adequate insulin to remove sugar from your blood [6]. Type 2 diabetes can increase your chances of a stroke, heart disease, vision problems, and chronic kidney disease [2]. When you have prediabetes, you are more likely to develop type 2 diabetes and its complications [9]. According to a recent study, 57.5% of women and 46.1% of men with prediabetes will develop type 2 diabetes [8]. Simple lifestyle changes can help you prevent prediabetes from progressing into type 2 diabetes.

How can you reverse prediabetes?

If you want to reverse prediabetes, adding healthy foods to your diet, exercising regularly, and maintaining a healthy weight are important [9]. Eating less processed foods and avoiding sugar-sweetened beverages are easy ways to reduce the amount of sugar you consume daily. You can improve your diet by adding more fruits and vegetables and healthy fats such as olive oil and nuts.

The Diabetes Prevention Program (DPP) trial results guide healthcare providers' recommendations for lifestyle interventions [9]. The DPP lifestyle intervention recommends losing approximately 7% of your body weight and exercising 150 minutes hour per week to reduce your chances of developing type 2 diabetes [9]. Depending on your health status, your healthcare provider will determine how much bodyweight you can safely lose and the best exercise routine for you. Your preexisting health conditions, age, sex, and commitment to lifestyle changes will determine how long it takes to reverse prediabetes. You can easily monitor your progress with at-home A1C tests.

Can prediabetes be reversed?

What are the warning signs of prediabetes?

Is diabetes genetic or hereditary?

What is normal HbA1c by age?

What is polydipsia?

References

  1. Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2020. Accessed December 6, 2022. URL
  2. Lawal Y, Bello F, Kaoje YS. Prediabetes Deserves More Attention: A Review. Clin Diabetes. 2020;38(4):328-338. doi:10.2337/cd19-0101. URL
  3. Prediabetes Risk Test. Cdc.gov. Accessed December 7, 2022. URL
  4. Fang M, Wang D, Echouffo-Tcheugui JB, Selvin E. Prediabetes and Diabetes Screening Eligibility and Detection in US Adults After Changes to US Preventive Services Task Force and American Diabetes Association Recommendations. JAMA. 2022;327(19):1924. doi:10.1001/jama.2022.5185. URL
  5. Alvarez S, Coffey R, Algotar AM. Prediabetes. In: StatPearls [Internet]. StatPearls Publishing; 2022. URL
  6. Draznin B, Aroda VR, Bakris G, et al; American Diabetes Association Professional Practice Committee; American Diabetes Association Professional Practice Committee. Classification and diagnosis of diabetes: standards of medical care in diabetes—2022. Diabetes Care. 2022;45(suppl 1):S17-S38. doi:10.2337/dc22-S002. URL
  7. Eyth E, Basit H, Swift CJ. Glucose Tolerance Test. In: StatPearls [Internet]. StatPearls Publishing; 2022. URL
  8. Van Herpt TTW, Ligthart S, Leening MJG, et al. Lifetime risk to progress from pre-diabetes to type 2 diabetes among women and men: comparison between American Diabetes Association and World Health Organization diagnostic criteria. BMJ Open Diabetes Res Care. 2020;8(2):e001529. doi:10.1136/bmjdrc-2020-001529. URL
  9. American Diabetes Association Professional Practice Committee. 3. Prevention or delay of type 2 diabetes and associated comorbidities: Standards of Medical Care in diabetes-2022. Diabetes Care. 2022;45(Suppl 1):S39-S45. doi:10.2337/dc22-S003. URL
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