Pre-diabetes, the leading risk factor for type 2 diabetes, is a wake-up call. Pre-diabetes is defined as an intermediate stage of blood sugar level where one has a higher than normal blood sugar level but not high enough to be considered type 2 diabetes. But without lifestyle changes, adults and children with pre-diabetes are at high risk to develop type 2 diabetes. 

Diagnostic criteria for pre-diabetes are as follows:

1. Impaired fasting glucose (IFG)- when fasting blood glucose level falls between 100-125 mg/dl (5.6-6.9 mmol/L). 
2. Impaired glucose tolerance test (IGT)- when the result of a 2-hour oral glucose tolerance test (OGTT) falls between 140-199 mg/dl (7.8-11.0 mmol/L).
3. HbA1C (glycosylated haemoglobin)-  when Hb1Ac range between 5.7-6.4% (39-47 mmol/mol) is suggestive of pre-diabetes.This is an indicator of an average blood glucose level over the past 3 months. Hb1AC is a measure of hemoglobin within blood cells that is coated with glucose. If one has a high level of glucose in the blood, more glucose will stick to the hemoglobin molecule and HbA1C will be increased. 

In pre-diabetes, the long-term damage of diabetes to the heart, blood vessels, and kidneys may already be starting. Many people who improve their lifestyle habits are able to prevent type 2 diabetes; some are even able to reverse pre-diabetes.

Eating healthy foods, making physical activity part of your daily routine, and staying at a healthy weight can help bring your blood sugar level back to normal. The same lifestyle changes that can help prevent type 2 diabetes in adults might also help bring children’s blood sugar levels back to normal.

Causes

The exact cause of pre-diabetes is unknown. But family history and genetics appear to play an important role. What is clear is that people with pre-diabetes don’t process sugar (glucose) properly anymore. Most of the glucose in your body comes from the food you eat. When food is digested, sugar enters our bloodstream. Insulin allows sugar to enter cells and lowers the amount of sugar in the blood. 

Insulin is produced by a gland located behind the stomach called the pancreas. The pancreas sends insulin to the blood when we eat. When blood sugar level starts to drop, the pancreas slows down the secretion of insulin into the blood. In pre-diabetes, this process doesn’t work as well. As a result, instead of fueling our cells, sugar builds up in our bloodstream. This can happen because the pancreas may not make enough insulin and cells become resistant to insulin and don’t allow as much sugar to go to cells to produce energy. 

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Risk factors

The same factors that increase the odds of getting type 2 diabetes also increase the risk of pre-diabetes. These factors include:

• Weight- Being overweight is a primary risk factor. The more fatty tissue inside and between the muscle and skin around the abdomen causes cells to become more resistant to insulin which results in an increase in blood sugar levels.
• Waist size- a large waist size can indicate insulin resistance. The risk of insulin resistance goes up for men with waists larger than 40 inches and for women with waists larger than 35 inches.
• Diet- eating red meat and processed meat, and drinking sugar-sweetened beverages, are associated with a higher risk of pre-diabetes.
• Inactivity- less physical activity increases the risk of this condition.
• Age- although diabetes can develop at any age, the risk of pre-diabetes increases after age 45.
• Family history- the risk increases if one has a parent or sibling with type 2 diabetes.
• Race or ethnicity- Black, Hispanic, American Indian, and Asian American people are more likely to develop pre-diabetes, although it is unlikely to explain why?
• Gestational diabetes- if a female has diabetes while pregnant (gestational diabetes), the mother and child are at higher risk of developing pre-diabetes.
• Polycystic ovary syndrome- women with this common condition, characterized by irregular menstrual periods, excess hair growth, and obesity have a higher risk of developing the condition.
• Sleep- people with obstructive sleep apnea, a condition that disrupts sleep repeatedly, have an increased risk of insulin resistance. People who are overweight or obese have a higher risk of developing obstructive sleep apnea.
• Tobacco smoke- smoking may increase insulin resistance and can increase the risk of type 2 diabetes in people with pre-diabetes. 

Other conditions associated with an increased risk of pre-diabetes include high blood pressure, low levels of high-density lipoprotein (HDL) cholesterol, the “good” cholesterol, and high levels of triglycerides – a type of waxy fat in our blood. 

Complications

Pre-diabetes has been linked with long-term damage, including to the heart, blood vessels, and kidneys, even if we have not progressed to type 2 diabetes. Pre-diabetes is also linked to an unrecognized (silent) heart attack.

Pre-diabetes can progress to type 2 diabetes, which can lead to high blood pressure and cholesterol, heart disease, stroke, kidney disease, nerve damage, fatty liver disease, and eye damage, including loss of vision and amputations.

Prevention

Healthy lifestyle choices can help you prevent pre-diabetes and its progression to type 2 diabetes. These include:

• Eating healthy foods
• Physical activity
• Losing excess weight
• Management of healthy blood pressure and cholesterol
• No smoking
• Good sleep
• No stress