Prediabetes is a precursor before the diagnosis of diabetes mellitus. Adults with prediabetes often may show no signs or symptoms of diabetes but will have blood sugar levels higher than normal. The normal blood glucose level is between 70 mg/dL to 99 mg/dL. In patients with prediabetes, you can expect to see blood glucose levels elevated between 110 mg/dL to - 125 mg/dL. However, these levels do not meet the required criteria for a diagnosis of diabetes mellitus. For this reason, many people are not aware that they are living with prediabetes.
In addition to type 2 diabetes, prediabetes is a risk factor for the development of cardiovascular disease, and stroke. Once diagnosed with prediabetes patients should be checked for progression to type 2 diabetes every one to two years. If screening is negative for prediabetes, repeat screening should be carried out every 3 years as per the United States Preventive Services Task Force (USPSTF). Lifestyle changes through improved nutrition and physical activity are the firstline treatment for preventing the transition from prediabetes to diabetes which can be as high as 70%.
The following factors put the patient at greater risk:
According to the Center for Disease Control and Prevention, about 84 million American adults are currently facing prediabetes. This equals one in three adults in America. About 90% of these adults do not know that they are currently living with prediabetes and setting themselves up for all the implications this entails. The incidence of diabetes is evidently growing at rapid rates globally. In America alone, about 1.5 million Americans are being diagnosed with diabetes every year. These increases are parallel with the rapid increases in the prevalence of obesity. Annually, diabetes remains the seventh cause of death in the United States and is currently costs about $245 billion in the United States. Due to this, preventing this trending progression should be at the top of the list as a national health focus and strategy. The focus on management and diagnostic studies should come second given that this disease is preventable.
Since prediabetes is the precursor for diabetes mellitus, the pathophysiology is relatable. Hyperglycemia will cause production and release of insulin by the pancreatic beta cells. Excess insulin exposure for long periods of time diminishes the reponse of the insulin receptors the function of which is to open glucose channels leading to entry of glucose into the cells. Decreased function of the insulin receptors leads to further hyperglycemia further perpetuating the metabolic disturbance and leading to the development of not only diabetes type 2 but also metabolic syndrome. In prediabetes, this process is not to the extent of diabetes mellitus but is a first step in a metabolic cascade which has potentially dangerous consequences if not adequately addressed. Hence its imperative to start treatment at the earliest.  If treatment is not started or if the treatment is not adequate, adverse effects on large and small blood vessels (e.g. arteries of the cardiovascular system or retina, kidney, and nerves) may occure.
In majority of the patients with prediabets do not experience any symptoms and hence appropriate screening and monitoring especially in individuals with family history is needed. In the minority of patients who do experience symptoms, they can be as follows:
The single sign of prediabetes is elevated blood glucose on a blood test that is not high enough to be classified as type 2 diabetes mellitus.
The following tests can be used to screen for prediabetes:
The most important management in prediabetes is a lifestyle change and promotion of intense weight loss. Reducing weight by 7% through a low-fat diet, in addition to an exercise regimen of about 30 minutes per day, is the overall goal of management. 
Approximately 70% of people with prediabetes will go on to be diagnosed with diabetes mellitus. However, this is not inevitable. Prediabetes managed appropriately can prevent diabetes mellitus and lower the risk of cardiovascular disease.
Some patients will need to take some medications. These patients include those that have failed to maintain adequate lifestyle therapy or are at high-risk for developing type 2 diabetes. The most common medications used for prediabetes are metformin and acarbose, which will help prevent the development of diabetes mellitus. These two drugs have minimal side effects and work well in prediabetic patients.
Prevention is the key of prediabetes. The best preventative measures are:
Many studies suggest that a low-carbohydrate diet can help control insulin resistance, blood glucose levels, and weight issues. Consuming low sodium at levels less than 1500 mg per day, limiting alcohol to zero or one drink per day, and cutting out added sugar and unhealthy fats will also help prevent prediabetes from developing. Prediabetes is reversible and can only be managed by making these significant lifestyle changes and having physicians who know how to educate patients on adopting healthier lifestyle habits.
Today a great deal of effort is based on reversing the prediabetic state. This is best done in a multidisciplinary fashion that involves an endocrinologist, bariatric surgeon, dietitian, pharmacists, weight loss nurse and a physical therapist. The patient should be educated on the importance of exercise and discontinuation of smoking. Further, the blood pressure must be well controlled and the hyperlipidemia lowered. The patient must be educated on the importance of eating a healthy diet and remaining compliant with medications to lower the blood glucose and cholesterol. (Level V)
Many studies have sown that there is a relationship between persistently elevated blood glucose levels and risk for adverse cardiac events and death. Evidence shows that individuals with prediabetes are susceptible to many metabolic complications that may lead to blindness, stroke, heart disease, and renal failure. These individuals are also at a high risk for developing peripheral neuropathy and loss of limb. Further, the elevation of blood glucose during pregnancy also increase the risk of maternal and fetal mortality. (Level V)
We are looking for contributors to author, edit, and peer review our vast library of review articles and multiple choice questions. In as little as 2-3 hours you can make a significant contribution to your specialty. In return for a small amount of your time, you will receive free access to all content and you will be published as an author or editor in eBooks, apps, online CME/CE activities, and an online Learning Management System for students, teachers, and program directors that allows access to review materials in over 500 specialties.
This is an academic project designed to provide inexpensive peer-reviewed Apps, eBooks, and very soon an online CME/CE system to help students identify weaknesses and improve knowledge. We would like you to consider being an author or editor. Please click here to learn more. Thank you for you for your interest, the StatPearls Publishing Editorial Team.
Click Your Answer Below
Would you like to access teaching points and more information on this topic?
Click Your Answer Below
Would you like to access teaching points and more information on this topic?
|Horstman C,Aronne L,Wing R,Ryan DH,Johnson WD, Implementing an Online Weight-Management Intervention to an Employee Population: Initial Experience with Real Appeal. Obesity (Silver Spring, Md.). 2018 Sep 27 [PubMed]|
|Moin T,Damschroder LJ,AuYoung M,Maciejewski ML,Havens K,Ertl K,Vasti E,Weinreb JE,Steinle NI,Billington CJ,Hughes M,Makki F,Youles B,Holleman RG,Kim HM,Kinsinger LS,Richardson CR, Results From a Trial of an Online Diabetes Prevention Program Intervention. American journal of preventive medicine. 2018 Sep 19 [PubMed]|
|Stepanek L,Horakova D,Nakladalova M,Cibickova L,Karasek D,Zadrazil J, Significance of prediabetes as a nosological entity. Biomedical papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia. 2018 Sep 24 [PubMed]|
|DiBonaventura M,Nicolucci A,Meincke H,Le Lay A,Fournier J, Obesity in Germany and Italy: prevalence, comorbidities, and associations with patient outcomes. ClinicoEconomics and outcomes research : CEOR. 2018 [PubMed]|
|Granados A,Gebremariam A,Gidding SS,Terry JG,Carr JJ,Steffen LM,Jacobs DR Jr,Lee JM, Association of abdominal muscle composition with prediabetes and diabetes: The CARDIA study. Diabetes, obesity [PubMed]|
|Anothaisintawee T,Lertrattananon D,Thamakaison S,Thakkinstian A,Reutrakul S, The Relationship Among Morningness-Eveningness, Sleep Duration, Social Jetlag, and Body Mass Index in Asian Patients With Prediabetes. Frontiers in endocrinology. 2018 [PubMed]|
|Armato JP,DeFronzo RA,Abdul-Ghani M,Ruby RJ, Successful treatment of prediabetes in clinical practice using physiological assessment (STOP DIABETES). The lancet. Diabetes [PubMed]|
|Kim SE,Castro Sweet CM,Gibson E,Madero EN,Rubino B,Morrison J,Rosen D,Imberg W,Cousineau MR, Evaluation of a digital diabetes prevention program adapted for the Medicaid population: Study design and methods for a non-randomized, controlled trial. Contemporary clinical trials communications. 2018 Jun [PubMed]|
|Chen ME,Aguirre RS,Hannon TS, Methods for Measuring Risk for Type 2 Diabetes in Youth: the Oral Glucose Tolerance Test (OGTT). Current diabetes reports. 2018 Jun 16 [PubMed]|
|Blackett P,George M,Wilson DP, Integrating lipid screening with ideal cardiovascular health assessment in pediatric settings. Journal of clinical lipidology. 2018 Aug 29 [PubMed]|
|Lim WY,Ma S,Heng D,Tai ES,Khoo CM,Loh TP, Screening for diabetes with HbA1c: Test performance of HbA1c compared to fasting plasma glucose among Chinese, Malay and Indian community residents in Singapore. Scientific reports. 2018 Aug 20 [PubMed]|
|Kamble PS,Collins J,Harvey RA,Prewitt T,Kimball E,Deluzio T,Allen E,Bouchard JR, Understanding Prediabetes in a Medicare Advantage Population Using Data Adaptive Techniques. Population health management. 2018 Apr 12 [PubMed]|
|Soltero EG,Konopken YP,Olson ML,Keller CS,Castro FG,Williams AN,Patrick DL,Ayers S,Hu HH,Sandoval M,Pimentel J,Knowler WC,Frick KD,Shaibi GQ, Preventing diabetes in obese Latino youth with prediabetes: a study protocol for a randomized controlled trial. BMC public health. 2017 Mar 16 [PubMed]|
|Robert AA,Al Dawish MA,Braham R,Musallam MA,Al Hayek AA,Al Kahtany NH, Type 2 Diabetes Mellitus in Saudi Arabia: Major Challenges and Possible Solutions. Current diabetes reviews. 2017 [PubMed]|
|Bowen ME,Schmittdiel JA,Kullgren JT,Ackermann RT,O'Brien MJ, Building Toward a Population-Based Approach to Diabetes Screening and Prevention for US Adults. Current diabetes reports. 2018 Sep 19 [PubMed]|
The intent of StatPearls is to provide practice questions and explanations to assist you in identifying and resolving knowledge deficits. These questions and explanations are not intended to be a source of the knowledge base of all of medicine, nor is it intended to be a board or certification review of NP-Adult Acute Gerontology. The authors or editors do not warrant the information is complete or accurate. The reader is encouraged to verify each answer and explanation in several references. All drug indications and dosages should be verified before administration.
StatPearls offers the most comprehensive database of free multiple-choice questions with explanations and short review chapters ever developed. This system helps physicians, medical students, dentists, nurses, pharmacists, and allied health professionals identify education deficits and learn new concepts. StatPearls is not a board or certification review system for NP-Adult Acute Gerontology, it is a learning system that you can use to help improve your knowledge base of medicine for life-long learning. StatPearls will help you identify your weaknesses so that when you are ready to study for a board or certification exam in NP-Adult Acute Gerontology, you will already be prepared.
Our content is updated continuously through a multi-step peer review process that will help you be prepared and review for a thorough knowledge of NP-Adult Acute Gerontology. When it is time for the NP-Adult Acute Gerontology board and certification exam, you will already be ready. Besides online study quizzes, we also publish our peer-reviewed content in eBooks and mobile Apps. We also offer inexpensive CME/CE, so our content can be used to attain education credits while you study NP-Adult Acute Gerontology.