What is pre-diabetes?

Pre-diabetes is a build-up of glucose (or sugar) in your blood caused by a shortage of insulin or cell resistance to this hormone.

The pancreas, an organ behind the stomach, secretes the hormone insulin to enable the cells in your body to use glucose as fuel. In people with pre-diabetes, insulin doesn't work as it should, failing to support the normal absorption of glucose in the cells.

To compensate for this, the pancreas works harder to produce insulin but fails to keep up with the demand. The result is a higher blood sugar concentration than normal, significantly increasing the risk for type 2 diabetes.

According to the US national public health agency, Centers for Disease Control and Prevention (CDC), over 84% of those with pre-diabetes don't know they have the condition. Pre-diabetes is often discovered through blood tests and may or may not be accompanied by symptoms.

According to the CDC, you have pre-diabetes if your blood tests show one of the following results:

• Fasting blood sugar test - 5.6 to 6.9 mmol/L (blood sugar levels after not eating overnight).
• A1C test - 5.7 to 6.4% (haemoglobin proteins coated with sugar).
• Glucose tolerance test - 7.8 to 11.0 mmol/L (the amount of glucose in your bloodstream after fasting and then drinking at fixed intervals a sugary drink).

Unlike full-blown diabetes, pre-diabetes may be reversed. This may even be possible without medication, through diet and lifestyle changes.

Causes and risk factors

People with pre-diabetes cannot process glucose normally - the main type of sugar in the bloodstream and the main energy source of cells - and this accumulates in the blood. For some people, the cause is cell resistance to insulin. For others, the insufficient production of this hormone.

The exact mechanism behind the development of pre-diabetes is not known. However, apart from genetics, several risk factors for pre-diabetes are widely recognized:

Complications

Having pre-diabetes was linked to a 15% higher risk of heart and circulation problems and a 13% higher risk of dying from any cause.

According to the same source, pre-diabetes is especially dangerous for people with heart disease, increasing the risk of all cardiovascular diseases and all-cause mortality by 37% and 36% percent, respectively.

Left unchecked, pre-diabetes can progress to type 2 diabetes. An article published in The Lancet notes that up to 70% of individuals with pre-diabetes go on to develop type 2 diabetes, a condition that causes many complications, including:

Treatment and prevention

The main treatment for pre-diabetes tends to include dietary and lifestyle changes rather than medication.

Metformin may be prescribed to pre-diabetes patients considered at high risk of developing type 2 diabetes. However, while some studies support its efficacy, this medication is controversial.

Additional medication for managing high blood pressure and cholesterol may also be prescribed to limit the risk of cardiovascular disease.

Diet

Eating right is one of the best ways to manage pre-diabetes and possibly check it before it can develop into type 2 diabetes. Diet, alongside other controllable factors, can also help prevent pre-diabetes.

• Watch out for the glycaemic index of foods or how fast a particular food raises your blood sugar level. Eat foods with a low glycaemic index (GI).
• Avoid processed foods and refined carbs such as white bread, white rice, or russet potatoes.
• Eat more fibre-rich foods, including whole grains, fruits, and vegetables.
• Avoid foods high in fat and calories.
• Don't drink sugary drinks such as soda or juices - eat fruits or drink unsweetened tea instead.
• Eat healthy protein sources such as beans, legumes, soybean, fish, and lean meat.
• Drink plenty of water.
• Drink alcohol in moderation or give it up altogether.
• Stop smoking.

Other ways to treat and prevent pre-diabetes

In addition to dietary changes, a few other lifestyle changes are effective against pre-diabetes:

• Reduce your body weight if necessary. Exercising regularly and reducing your body weight by about 5% could reduce your risk of getting diabetes by more than 50% (NHS Inform).
• Exercise for at least 150 minutes per week or 30 minutes a day. Coupled with a weight loss strategy, daily aerobic exercise can reduce the risk of pre-diabetes progressing to type 2 diabetes by 58%. Walking instead of driving, riding a bike, taking the steps, and going to the gym can all make a difference.
• Manage stress through meditation and other strategies. Stress associated with pre-diabetes may make it difficult for you to follow your dietary and exercise goals.