What is prediabetes?

Prediabetes indicates that blood sugar levels are higher than they should be. If left unaddressed, these higher-than-average levels can develop into type 2 diabetes. Having prediabetes can put someone at high risk for kidney failure, nerve damage and even a stroke or heart attack. However, lifestyle changes and medical treatment can improve prediabetes and lower these health risks.

The first step to addressing the risks that prediabetes poses is to understand it, its range of causes and the different ways to identify and stop its progression. Read on to learn more.

In this article:

Understanding prediabetes

Prediabetes is a fairly common condition. In fact, over one-third of adults in the U.S. are prediabetic.

While a hallmark symptom of prediabetes is higher-than-average blood glucose levels, the condition also involves insulin resistance.

Once insulin resistance starts to happen, the pancreas, which produces the insulin, responds by producing more insulin in an effort to help lower blood sugar levels. Over time, the pancreas may not be able to sustain this rate of insulin production. This results in blood sugar rising even higher.

Prediabetes vs. diabetes

While prediabetes can develop into type 2 diabetes if left untreated, it isn’t the same thing as diabetes.

Both conditions do involve higher-than-normal levels of blood sugar (blood glucose), but these levels are notably higher in people with type 2 diabetes than with prediabetes. If someone’s A1C (average blood sugar level) ranges from 5.7 to 6.4 percent over the past 90 days, they are within the prediabetic range. If it measures at 6.5 percent or higher, they are considered diabetic.

It is important to note that the effects of prediabetes on the body can be slowed or reversed with proper lifestyle changes and/or medical interventions.

Prediabetes symptoms

Although it is a possible precursor to a type 2 diabetes diagnosis, prediabetes often appears without any symptoms, meaning someone may not experience any early signs or symptoms that alert them to the risk of developing diabetes. Or someone might experience symptoms that might otherwise seem unrelated.

For example, possible signs of prediabetes that people may not attribute to the condition include skin tags that develop in areas like the neck or armpits.

Prediabetes causes and risk factors

There are a variety of risk factors and potential causes of prediabetes. Some might be influenced by genetics, and others might be based on factors like one’s physical activity level or diet and lifestyle.

These risk factors are important to monitor with guidance from a health care provider, because up to 70 percent of people with prediabetes are predicted to develop type 2 diabetes over time.

Risk factors

Understanding the risk factors for both prediabetes and type 2 diabetes can help someone better understand their comprehensive risk profile. It can also encourage people to monitor their health more effectively and make beneficial lifestyle changes in an effort to avoid the condition (or its progression).

The most common prediabetes or type 2 diabetes risk factors include the following:

• Having gestational diabetes or giving birth to a baby who weighed over nine pounds
• Having a family history of type 2 diabetes
• Being overweight or obese
• Maintaining minimal levels of physical activity (less than three times a week)
• Having polycystic ovarian syndrome (PCOS)
• Smoking
• Being over 45 years old
• Being African American, an Alaska Native, Hispanic, Latino, Native American or a Pacific Islander

While some of these risk factors are preventable with a healthy, balanced diet and adequate physical activity, other risk factors are genetic or otherwise not modifiable. Being mindful of risk factors for type 2 diabetes and prediabetes can help prevent these disorders.

Prediabetes testing and diagnosis

While prediabetes may not be apparent from signs and symptoms alone, “weight gain, difficulty losing weight, skin tags, or darkening of the skin in the armpits or on the back of the neck (acanthosis nigricans) may be signs and symptoms of prediabetes,” says Jennie Stanford, M.D., FAAFP, DipABOM, a board-certified physician and obesity medicine specialist. If someone has any concerning signs or symptoms or if they know they have prediabetes risk factors, they may consider medical tests to look for early identification and formal diagnosis.

One of the most common tests for prediabetes diagnosis is a hemoglobin A1C test (also known as an HbA1C test). This test measures average blood glucose levels over the past three months. If results come back between 5.7 percent and 6.4percent, a person is in the prediabetic range.

A second test to consider for prediabetes diagnosis is a fasting blood glucose test. As the name suggests, this is typically done after 12 hours of overnight fasting. Blood sugar measurements of 100 to 125 milligrams per deciliter (mg/dL) confirm a diagnosis of prediabetes.

Another common test is the two-hour glucose tolerance test. In this test setting, a health care provider will take an initial blood draw to assess the baseline blood sugar level. After the draw is over, they will have the patient drink a liquid that contains approximately 75 grams of sugar. Blood will then be drawn immediately after and two hours after ingestion to determine glucose level ranges. If the ranges fall between 140 mg/dL and 199 mg/dL, a prediabetes diagnosis is confirmed.

Lastly, blood insulin levels may be helpful in identifying cases of early prediabetes. Fasting insulin levels are one of the first markers to rise when prediabetes develops, indicating insulin resistance.

Children and testing

Prediabetes levels in children have risen in recent years, according to research. Recent studies even found prediabetes present in up to 8.84percent of children in the 48 communities included in the study.

Research suggests that one major factor for the increase in children developing prediabetes is a shift in overall lifestyle and nutrition following the COVID-19 pandemic. This shift has also been suggested to be partly responsible for the significant increase in cases of childhood obesity observed by health care experts.

While research is still ongoing in terms of childhood diabetes and prediabetes detection and prevention , there are a few testing methods that are reliably used by pediatricians and specialists. These common prediabetes tests for children and adolescents include the standard HbA1C blood test and the two-hour glucose tolerance test.

Health complications

Prediabetes doesn’t necessarily affect the body the same way as type 2 diabetes might. However, there are still health complications and risks that can occur as a result of living with prediabetes. For example, prediabetes can increase one’s chances of developing heart disease, having a stroke or being diagnosed with type 2 diabetes.

Type 2 diabetes increases the likelihood of several serious health issues. These added risks can include blindness, kidney failure, or neurological and circulatory dysfunction.

Prediabetes management and treatment

If someone is aware that they have prediabetes (or suspect that they might), there are several methods for treating and managing the impact it can have on the body.

Lifestyle modifications

Being overweight can significantly increase the risk of a prediabetes or diabetes diagnosis. Current data suggests that the more someone loses weight and improves cardiovascular health, the more they can lower their risk of developing type 2 diabetes.

Medical interventions

Other options besides diet and lifestyle changes may include medication. An example of a common prediabetes medication would be metformin, a medication that decreases the amount of glucose produced by the liver and increases the body’s insulin sensitivity. This allows the body to turn blood sugar into energy more effectively.

A second common prediabetes medication is a glucose inhibitor known as acarbose, which in some studies was shown to decrease the risk of participants developing type 2 diabetes from prediabetes by 25percent.

Lastly, a health care provider might prescribe a glucagon-like peptide-1 (GLP-1) or gastric-inhibitory polypeptide (GIP) receptor agonist, such as semaglutide or tirzepatide injections, to address prediabetes or type 2 diabetes proactively. These medications help promote weight loss and improve blood sugar control in many. They may possibly reduce the risk of complications that can be  a result of prediabetes or type 2 diabetes.

Preventing prediabetes

Lifestyle habits are one of the biggest considerations that can impact the risk of developing prediabetes or type 2 diabetes, possibly preventing the serious complications that can be associated with either condition.

People at risk of developing prediabetes can reverse its development through a nutritional diet focused on protein, lots of non-starchy vegetables and healthy whole grains. Physical activity is also crucial to managing the risk of developing diabetes. Just 150 minutes or more of moderate exercise a week can improve the risk profile for prediabetes or related conditions.

When to see a health care provider

As with other medical concerns, it’s always a good idea to see a health care provider regularly. Consistently, checking in about health can allow a health care provider to adequately detect, diagnose and treat symptoms or risks of prediabetes and beyond.

Traditionally, associated symptoms may or may not be present in people with prediabetes. If someone is concerned about risk factors like family history, lifestyle changes or weight , it’s best to seek medical advice on how to manage and prevent prediabetes.

Frequently asked questions

What are the symptoms of being prediabetic?

Prediabetes doesn’t always have clear symptoms, which is why it often goes undetected until serious health problems arise. Some people with prediabetes may have small skin growths or darkened skin in the armpit or on the back and sides of the neck.

Can prediabetes go away?

Yes. Changes in dietary intake, increased physical activity and weight loss and can help reverse prediabetes.

How is prediabetes treated?

Prediabetes can be treated with lifestyle modifications like weight loss and physical activity along with prescription medications like metformin.

How does someone know if they are prediabetic?

Prediabetes can be diagnosed with a few different blood tests, including a fasting plasma glucose (FPG) test or an A1C test. Individuals should consult their health care provider to discuss diagnosis and treatment.

Does prediabetes mean someone will definitely get diabetes?

No. Prediabetes can develop into diabetes without intervention, but lifestyle changes can help reverse prediabetes.

This content is for informational purposes only and is not medical advice. Consult your health care provider before taking any vitamins or supplements and prior to beginning or changing any health care practices.