Prediabetes and Why We Should Care About It

What Is Prediabetes?

Prediabetes, or borderline diabetes, is a condition in which blood glucose (sugar) levels are higher than they should be but not high enough for the doctor to diagnose diabetes.

In the US, about 10% of people with prediabetes develop diabetes each year.

Prediabetes is also linked to an increased risk of heart attack, congestive heart failure, stroke, kidney disease, peripheral nerve damage causing numbness and pain in the feet, and problems with vision.

Prediabetes treatment can prevent more serious health problems, including type 2 diabetes and problems with your heart, blood vessels, eyes, and kidneys.

Patients with type 2 diabetes almost always have prediabetes first. But it doesn’t usually cause symptoms.

The other terms used to call this condition are “impaired glucose tolerance”, “impaired fasting glucose”, “impaired glucose regulation”, “non-diabetic hyperglycemia”.

How Common Is Prediabetes?

Prediabetes affects approximately 98 million Americans, or more than 1 in 3 US adults, and about 720 million individuals worldwide. However, over 80% of patients don’t know they have it.

According to the Centers for Disease Control (CDC), 37% of Asian American adults aged 18 and older had prediabetes in 2019, which is higher than the 31.5% prevalence rate for non-Hispanic Whites. This means that one in two Asian Americans has prediabetes or is at risk of having diabetes.

Asian Americans are more likely than Caucasians to have prediabetes, even though they tend to have a lower body weight. This is due to a combination of genetic and environmental factors, including the fact that Asian Americans tend to have more visceral fat and less muscle than other groups.

Visceral fat surrounds internal organs and makes the body's tissues more insulin-resistant. This can lead to developing diabetes at a younger age.

Prediabetes information from the Centers for Disease Control

What Causes Prediabetes?

Insulin is a hormone made by the pancreas that is key to letting blood sugar into cells for use as energy. During prediabetes, the cells in our body don’t respond normally to insulin, which is known as insulin resistance.

Our pancreas needs to make more insulin to get cells to respond. Eventually, our pancreas can’t keep up, and our blood sugar rises, setting the stage for prediabetes—and type 2 diabetes down the road.

Doctors aren’t sure exactly why people develop insulin resistance. Some factors that contribute to insulin resistance are as follows:

Our genes
Excess body fat
Long-term stress
Sleep loss
Lack of exercise
Eating a lot of processed foods
Some hormonal conditions, such as Cushing’s syndrome and hypothyroidism
Medications such as steroid drugs used over a long period

What are the Symptoms of Prediabetes?

Most people with prediabetes often have no symptoms, so most people with prediabetes do not know they have it.

Some people may notice the following symptoms:

Thirstier than usual
Passing urine a lot
Blurred vision
More tired than usual
Darker skin in the armpits or neck
Having small skin growths in the armpits or neck

Some early diabetes symptoms that could affect women are:

Yeast and urinary tract infections
Longer and heavier periods
Reduced interest in sex
Vaginal dryness
Trouble getting pregnant

What are the Risk Factors for Prediabetes?

Some of the risk factors for developing prediabetes include:

Being older than 45 years
Having a waist size larger than 40 inches (man) and 35 inches (woman)
Being overweight or obese, especially if we carry fat around the belly
Have high cholesterol, triglycerides, low HDL or “good” cholesterol, and high LDL or “bad” cholesterol
Have sleep problems such as sleep apnea
Being physically active less than 3 times a week
Eat a lot of red and processed meat
Not eating enough fruits, vegetables, nuts, whole grains or olive oil
Drinking sugar-sweetened beverages
Having a parent or sibling with type 2 diabetes
Having a history of diabetes during pregnancy (gestational diabetes) or giving birth to an infant weighing more than 9 pounds
Having polycystic ovary syndrome
Race and ethnicity are also factors to consider: African Americans, Hispanic/Latino Americans, American Indians, Pacific Islanders, and some Asian Americans are at higher risk.

Who Should Be Screened for Prediabetes?

The US Preventive Services Task Force (USPSTF) recommends that adults aged 35 to 70 years who are overweight or obese should be screened for prediabetes with blood testing every 3 years.

The American Diabetes Association (ADA) recommends that everyone start getting screened for type 2 diabetes at age 45 and that Asians of any age get screened if their body mass index (BMI) is 23 or higher.

The ADA also recommends testing for prediabetes or type 2 diabetes in overweight or obese women.

How Is Prediabetes Diagnosed?

Prediabetes is diagnosed by a blood test that checks a person’s blood glucose level, typically with either a fasting glucose measurement or a hemoglobin A1c (HbA1c or “A1c”) measurement.

If you’re unsure if you’re at risk, take this online test or ask your healthcare professional about getting a blood sugar test.

Your doctor will do at least one of the following tests:

Fasting plasma glucose test
- Normal: if the blood sugar is <100 milligrams per deciliter (mg/dL)
- Prediabetes: if the blood sugar is 100-125 mg/dL
- Diabetes: if the blood sugar is 126 mg/dL or higher
Oral glucose tolerance test: First, you’ll have a fasting plasma glucose test. Then, you’ll drink something sugary. After 2 hours, a technician will take more blood for testing. The results are as follows:
- Normal: if blood sugar is less than 140 mg/dL after the second test
- Prediabetes: if the blood sugar is 140-199 mg/dL after the second test
- Diabetes: if the blood sugar is 200 mg/dL or higher after the second test
Hemoglobin A1c test: This blood test shows your average blood sugar levels for the past 2-3 months. Doctors use this test in those who have diabetes to see if their blood sugar levels are under control. They can also use it to diagnose prediabetes or diabetes. The results are as follows:
- Normal: If it is 5.6% or less
- Prediabetes: If it is 5.7% to 6.4%
- Diabetes: if it is 6.5% or above

What Lifestyle Changes Are Recommended for People with Prediabetes?

The main treatment for prediabetes is a healthy lifestyle that includes the following:

Eating a healthy diet
Losing weight, if you need to
Exercise regularly
Stop smoking
Get blood pressure and cholesterol under control

What Dietary Changes Help with Prediabetes?

There is no official diet, but the following dietary changes can help reverse prediabetes and lower the chances of getting type 2 diabetes:

Choose whole grains and whole-grain products over processed carbohydrates such as white bread, potatoes, and breakfast cereals
Drink coffee, water, and tea instead of soda and juice
Choose good fats such as vegetable oil, nuts, and seeds over margarine, baked goods, and fried foods
Trade red meat and processed meats for nuts, whole grains, vegetables and fruits
Use olive oil instead of lard or butter
Monitor portion sizes

Some healthy eating plans that can lower the chances of diabetes include:

Mediterranean diet
Plant-based (vegetarian or vegan)
Low-fat
DASH (dietary approach to stop hypertension) diet

If you are unsure how to plan your meals, ask your doctor. They can refer you to a registered dietitian nutritionist. They can come up with a plan you can stick to.

Watch Swami Mukundananda’s healthy food tips for diabetes control

What Exercises I Can Do for Prediabetes?

When we exercise, the body uses sugar in the blood to fuel the workout. Over time, regular physical activity can lower overall glucose levels. We become more sensitive to insulin in the body, which makes it easier for the muscles to use the glucose.

We should get at least 150 minutes per week of moderate exercise. Aim for 30 minutes a day, 5 days a week. We don’t have to do anything intense. We can

Go for a brisk walk (at least 2.5 mph)
Try aerobics
Take yoga class
Take dance class
Bike (slower than 10 mph)

We may want to add a couple of days of strength or resistance training exercises.

Watch Swami Mukundananda teaching 5 Yoga Asanas for diabetes control

Can Weight Loss Lower the Risk?

If you have prediabetes, losing a small amount of weight, if you’re overweight, and getting regular physical activity can lower your risk for developing type 2 diabetes.

A small amount of weight loss means around 5% to 7% of your body weight, just 10 to 14 pounds for a 200-pound person. Shedding 5% to 10% of body weight can lower the risk of diabetes by 50%!

Studies show that with every 1 kg decrease in weight, the risk of developing diabetes in the future is reduced by 16%.

How is Sleep Related to Prediabetes?

Studies show sleep loss can make controlling blood sugar and appetite harder.

This is the reason why the chances of obesity and type 2 diabetes go up if we sleep less than 5-6 hours every night. Chances are higher if the quality of sleep is bad as well.

If you have sleep problems, skip afternoon coffee. Avoid alcohol at bedtime. Talk to your doctor for treatment of insomnia.

Why Is It Important to Quit Smoking?

Studies show that people who smoke have a higher chance of prediabetes than nonsmokers.

High levels of nicotine make it harder for the body to use insulin.

Cigarette smoking also damages the cells in a way that experts think leads to diabetes. Thus, it is important to quit smoking.

How to Overcome Psychological, Social, and Motivational Obstacles?

Psychosocial problems are very common in patients with prediabetes.

Addressing cognitive, emotional, behavioral, and social factors could help overcome the psychological barriers to adherence to a healthy lifestyle.

Share your thoughts and feelings with family members and others to reduce stress and have a positive attitude.

Spend time doing something you genuinely like each day. Stress relaxation techniques such as meditation and congregation may help to overcome psychological barriers.

Watch Swami Mukundananda’s guided meditation for relaxation

Are There Medications for Prediabetes?

Although no medication is currently approved by the US Food and Drug Administration (FDA) for the treatment of prediabetes, some people with prediabetes who have other health conditions such as high blood pressure or obesity may benefit from medications such as metformin or glucagon-like peptide 1 (GLP-1) receptor agonists.

It is important to note that the lifestyle changes outlined above appear to be more effective in reversing prediabetes and preventing progression to diabetes than medications alone.

What is the National Diabetes Prevention Program?

The National Diabetes Prevention Program (National DPP) is a partnership of public and private organizations working to prevent or delay type 2 diabetes. Partners make it easier for people at risk for type 2 diabetes to participate in evidence-based lifestyle change programs to reduce their risk of type 2 diabetes.

The CDC has a National Diabetes Prevention Program that offers group support, a lifestyle coach, and a weekly lifestyle curriculum developed by the CDC.

Here are the testimonials from the participants who benefitted from the National Diabetes Prevention Program https://www.cdc.gov/diabetes/prevention/testimonials-participants.html

Ready to get started? Find a lifestyle change program (online or in person) that works for you.