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Prediabetes – is a condition when sugar blood levels are between the normal level and diabetes mellitus level. A patient with prediabetes partly meets the diagnostic criteria for diabetes. This condition is often referred to as borderline diabetes, and is classified into two types: impaired fasting glycaemia (IFG) and impaired glucose tolerance (IGT).

Impaired fasting glycaemia (impaired fasting glucose, IFG) is a pre-diabetic condition that is characterized by fasting blood glucose levels higher than normal but not reaching the diabetes mellitus levels. This condition is associated with insulin resistance, and progresses to type 2 diabetes mellitus if not properly controlled. Besides, impaired fasting glycaemia increases the risk of cardiovascular problems, though not that strongly in comparison with impaired glucose tolerance.

Whether you have this kind of prediabetes or not is shown by the fasting plasma glucose level test. Here, it is necessary to take into account the difference in IFG criteria according to the World Health Organization (WHO) and American Diabetes Association (ADA), which give different values for the normal range of fasting glucose in blood. According to WHO, the normal range of fasting plasma glucose levels is between 110 mg/dL (6.1 mmol/L) and 125 mg/dL (6.9 mmol/L). According to ADA, the normal range of fasting plasma glucose levels is between 100 mg/dL (5.6 mmol/L) and 125 mg/dL (6.9 mmol/L).

The risk of impaired fasting glycaemia progression into type 2 diabetes mellitus is 50% over 10 years. According to most recent studies, the progression takes less than three years in most of cases.

Impaired glucose tolerance (IGT) is a pre-diabetic condition of dysglycaemia (abnormal blood sugar levels) associated with insulin resistance and increased risk of cardiovascular problems. The latter is considerably higher in comparison with impaired fasting glycaemia. IGT may progress to type 2 diabetes mellitus with years.

Impaired glucose tolerance is defined by the glucose tolerance test result. According to the WHO and ADA criteria, two-hour glucose levels between 140 mg/dL (7.8 mmol/dL) and 199 mg/dL (11.0 mmol/dL) being a result of 75-g oral glucose tolerance test speak of the impaired glucose tolerance. These levels are higher than normal but are not high enough to be classified as diabetes mellitus. Note that the fasting glucose levels may be either normal or slightly elevated.

Prediabetes Causes and Symptoms

It would be wrong to speak of prediabetes as of a separate disease that may lead to diabetes mellitus. In fact, this is the earliest stage of diabetes. That is why the causes of prediabetes are the same as of type 2 diabetes mellitus (for more details, please read the “Causes of Diabetes” Section). Concerning the signs and symptoms of prediabetes, logically, they are the same as the general diabetes symptoms (for more details, please read the “Diabetes Symptoms” Section). Still, not all the symptoms of diabetes may be evident at the stage of prediabetes, which should be taken into account especially by the at-risk individuals, who answer the following diabetes risk factors:

  • Family history of diabetes mellitus
  • History of gestational diabetes
  • High-risk ethnic group (Asian race especially)
  • Body mass index ˃ 25
  • Triglycerides levels ˃ 200 or high density lipoprotein (HDL) levels ˂ 35
  • Hypertension
  • Known vascular disease
  • Prior fasting blood glucose ˃ 99
  • Markers of insulin resistance

To know whether you have prediabetes or not for sure, you need to undergo blood sugar testing, namely: fasting plasma glucose levels test, two-hour glucose tolerance test, and glycated hemoglobin test.

Preventing Progression to Type 2 Diabetes

Prevention of diabetes progression is the main goal for those diagnosed with prediabetes. To delay the onset of type 2 diabetes mellitus, one should lead a lifestyle that would preserve the function of pancreas β-cells and prevent microvascular and cardiovascular complications. This mainly concerns the issues of obesity and unhealthy diet, which are the main risk factors for type 2 diabetes. The principles of diabetes prevention are defined by the Lifestyle Intervention Guidelines developed by American College of Endocrinology (ACE) and American Association of Clinical Endocrinologists (AACE) specially for helping prediabetic patients prevent the onset of type 2 diabetes mellitus. Lifestyle Intervention Guidelines include:

  • Healthy low-fat, low-sugar, and low-salt diet
  • 45-minute set of physical exercises a day, 5 days a week
  • Reducing weight by 5-10%

Additionally, prediabetic patients should take into consideration the following lifestyle recommendation on the following issues:

  • Smoking. As smoking is one of the risk factors for diabetes, prediabetic smokers should plan quitting this habit.
  • Alcohol consumption. It is acceptable to drink alcohol only in moderate quantities and always with a meal.
  • Stress. Stress should be avoided, as it leads to hormonal imbalance including the levels and work of insulin.

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