MY DOCTOR TOLD ME I’M PREDIABETIC, WHAT NOW?

Diabetes is a condition where the body has lost its ability to regulate blood sugar. It is a very common condition and the 7th leading cause of death in the United States according to the Center for Disease Control and Prevention (CDC). About 10% of the United States has type 2 Diabetes with a much smaller number of people being diagnosed with type 1 diabetes. However, about 1 in 3 adults in the United States (86 million people) have a condition called prediabetes. This article will address prediabetes, why it’s important, and what you can do about it.

1. WHAT IS PREDIABETES?

Prediabetes is a condition where the body is already having trouble regulating blood sugar, but a person has not quite reached the point where they have full blown type 2 diabetes. The reason it’s important to know if you have prediabetes is because this makes the risk of developing type 2 diabetes very high. Among people with prediabetes, about 5-10% of them will go on to develop diabetes each year. In addition, prediabetes by itself already comes with an increased risk of heart attack, stroke, kidney disease, eye disease, and neuropathy compared to people who have normal blood sugar.

2. DIVING DEEPER INTO THE NUMBERS

There are 3 different tests used to diagnose diabetes and prediabetes. The first is called a fasting plasma glucose. This is your blood sugar level after not eating or drinking anything (besides water) for at least 8 hours. The second is called the hemoglobin A1C. This is the percentage of your hemoglobin (a protein in your blood) that has sugar molecules stuck to it. This gives an estimate of long term blood sugar and is not affected by eating right before the test. The third is called a 2 hour Oral Glucose Tolerance Test (OGTT). This is a test where a person is given a drink with 75g of glucose (sugar) and their blood sugar is measured 2 hours later. Each test has its own advantages and disadvantages. The 2 hour OGTT is rarely done in regular practice because it is very inconvenient. You can see how we diagnose prediabetes and diabetes below.
Fasting plasma glucose:
  • Normal: 70-99mg/dL
  • Prediabetes: 100-125mg/dL
  • Diabetes: >125mg/dL
Hemoglobin A1C:
  • Normal: <5.7%
  • Prediabetes: 5.7-6.4%
  • Diabetes: >6.4%
2 hour Oral Glucose Tolerance Test (OGTT):
  • Normal: <140mg/dL
  • Prediabetes: 140-199mg/dL
  • Diabetes: >199mg/dL
Diabetes can also be diagnosed in people with a random (nonfasting) plasma glucose level of more than 200mg/dL with signs or symptoms of diabetes. These include things like blurry vision, frequent urination and extreme thirst.

3. TREATMENT OF PREDIABETES

There are 3 different directions that people can go in if they have prediabetes: they can develop diabetes, they can stay in the prediabetic state, or they can reverse diabetes and go back to having normal blood sugar (normoglycemia). That’s right! Prediabetes is completely reversible.
The cornerstone of diabetes prevention is lifestyle intervention. A landmark study showed that intensive lifestyle intervention with at least 150 minutes per week of physical activity per week and weight loss of 7% of body weight resulted in a 58% reduction in progression to type 2 diabetes compared to the control group. For a person who weighs 200 lbs., this would equate to a weight loss of 14 lbs. While certainly not easy, this is achievable weight loss for people who put in the effort with some guidance.
Medication has also been studied in the prevention of progression of prediabetes to type 2 diabetes. The same study showed that metformin, a medication used in the treatment of type 2 diabetes, decreased the risk of people developing diabetes by 31%. In practice, I often counsel my patients on lifestyle modification and prescribe them metformin at the same time although this has not been studied.
Lastly, for people who are very overweight who have not been successful with lifestyle intervention, bariatric surgery may be appropriate. If you have been diagnosed with prediabetes, talk to your doctor about lifestyle intervention and the possibility of treatment with medication.

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