Doctors have several ways to assess if a patient is prediabetic, which is a condition where blood sugar levels are higher than normal but not yet high enough to be diagnosed as type 2 diabetes. Detecting prediabetes is important because it allows patients to make lifestyle changes to prevent or delay the onset of full-blown diabetes.
Tests to Diagnose Prediabetes
The main tests doctors use to diagnose prediabetes are:
- A1C test: This blood test provides an average blood sugar level over the past 2-3 months. An A1C between 5.7% and 6.4% indicates prediabetes.
- Fasting plasma glucose test: After fasting overnight, a blood sample is taken. A fasting plasma glucose between 100-125 mg/dL signals prediabetes.
- Oral glucose tolerance test: Patients fast overnight and then drink a sugary solution. Blood samples are taken before and 2 hours after drinking the solution. Prediabetes is diagnosed if the 2-hour blood sugar level is between 140-199 mg/dL.
Doctors may use one or a combination of these tests to screen patients for prediabetes. They will also take into account risk factors like family history, weight, inactivity, and age when deciding if further testing is warranted.
Risk Factors for Prediabetes
Doctors will assess patients for the following risk factors that make prediabetes more likely:
- Being overweight or obese: Excess weight, especially around the abdomen, increases risk.
- Sedentary lifestyle: Lack of physical activity increases risk.
- Family history: Having a parent, sibling, or child with type 2 diabetes increases risk.
- Age: Risk increases after age 45.
- Polycystic ovary syndrome (PCOS): This hormonal disorder increases prediabetes risk in women.
- High blood pressure: Having blood pressure over 135/80 mm Hg is a risk factor.
- Abnormal cholesterol: High triglycerides and low “good” HDL cholesterol increase risk.
- History of gestational diabetes: Women who developed diabetes during pregnancy are more likely to develop prediabetes.
- Sleep apnea: This sleep disorder has been linked to insulin resistance.
If a patient has multiple risk factors, doctors will be more alert to the possibility of prediabetes and may screen for it more frequently.
Prediabetes Screening Recommendations
Due to the rise in prediabetes and type 2 diabetes, major health organizations recommend screening for prediabetes in high-risk individuals, including:
- The American Diabetes Association recommends screening overweight or obese adults starting at age 45, or sooner if they have additional risk factors.
- The US Preventive Services Task Force advises screening all adults ages 40-70 who are overweight or obese.
- The American Academy of Clinical Endocrinologists recommends screening people over age 30 every 3 years or annually if risk factors are present.
But even patients without obvious risk factors may be screened if their doctor feels they could be at increased risk. The oral glucose tolerance test is the preferred screening method according to guidelines, but fasting plasma glucose or A1C can also be used.
Signs and Symptoms
Prediabetes often has no signs or symptoms that you can detect on your own. But some people with prediabetes may experience:
- Increased thirst
- Frequent urination
- Fatigue
- Blurred vision
- Slow healing of cuts or bruises
- Tingling or numbness in hands or feet
These develop because elevated blood sugar levels can start causing damage to blood vessels and nerves even in prediabetes. But many people have no symptoms at all, which is why screening is so important.
Preventing Progression to Diabetes
Identifying prediabetes early is critical because it allows patients to make lifestyle changes to prevent or delay type 2 diabetes. Losing a modest amount of weight, getting regular exercise, and improving diet can significantly reduce the risk of developing diabetes. Doctors may also prescribe metformin or other medications in some cases. Slowing progression to diabetes is essential to avoid complications like nerve, kidney, eye, and heart damage down the road.
Lifestyle Changes Recommended
Doctors advise patients identified as prediabetic to implement the following lifestyle changes:
- Weight loss: Losing just 5-10% of body weight through diet and exercise sharply reduces diabetes risk.
- Increase physical activity: 30 minutes per day of brisk walking or other moderate exercise lowers risk.
- Improve diet: Eating fewer calories, less fat, more fiber, and fewer carbs can help.
- Stress management: Chronic stress contributes to high blood sugar, so stress relief is important.
- Smoking cessation: Quitting smoking helps improve insulin resistance.
Doctors work closely with prediabetic patients to set achievable lifestyle goals and provide support in making these changes stick.
Medication Options
In some cases, doctors may prescribe certain medications to help prevent progression from prediabetes to diabetes. This includes:
- Metformin: The most common medication used lowers blood sugar levels and improves insulin sensitivity.
- Insulin therapy: May be used short term in people with severe prediabetes failing lifestyle changes.
- Other medications: Such as alpha-glucosidase inhibitors or pioglitazone may also be options.
Doctors closely monitor medication effects and safety and discontinue use if normal blood sugar levels are restored.
Importance of Follow-Up
Following diagnosis of prediabetes, doctors will set a plan for periodic follow-up testing to monitor if blood sugar levels normalize or continue to progress toward diabetes. Repeat testing helps determine if lifestyle interventions or medications are working. Doctors may repeat one of the tests used for initial diagnosis, such as A1C, fasting plasma glucose, or oral glucose tolerance test. They will likely test 1-2 times per year or more frequently if concerns arise.
Referral to a Dietitian
Doctors often refer prediabetic patients to a dietitian or nutritionist for help developing an optimal diet and meal plan to improve blood sugar control. Dietitians can provide education on:
- Recommended daily calorie intake for weight loss if needed
- Carbohydrate counting and glycemic index of foods
- Strategies to reduce sugar and refined carbohydrates
- Healthy food choices and meal planning for diabetes prevention
- Setting achievable dietary goals
Following a diet tailored to your needs and preferences is key to successfully controlling prediabetes long term.
Counseling for Lifestyle Changes
Altering lifelong habits around eating, exercise, and stress is challenging. Doctors may refer prediabetic patients to counseling or training programs that provide coaching on lifestyle modifications through:
- Fitness assessments and exercise plans
- Tools for self-monitoring food intake and activity
- Group or individual counseling sessions
- Ongoing social support and education
These programs facilitate the process of making diabetes-preventing lifestyle changes and sticking to them.
Conclusion
Identifying prediabetes early through blood tests and evaluation of risk factors allows patients to take action to prevent progression to type 2 diabetes. Doctors guide patients on making impactful lifestyle improvements through weight loss, exercise, diet changes, and stress reduction. Medications may also be used in some cases for diabetes prevention. Follow-up testing and referral to dietitians or lifestyle coaches helps optimize blood sugar control. Taking these steps promptly when prediabetes is diagnosed gives patients the best chance of avoiding lifelong diabetes treatment and complications.