Diabetes mellitus (DM) is a disease that causes the blood sugar or blood glucose (BG) levels in your blood to be high. Type 2 diabetes is the most common type of DM. When someone has type 2 diabetes, their body makes insulin, but it does not work properly. Insulin is an essential hormone that our body needs to turn food into energy and to manage our blood sugar levels. When the insulin our body makes doesn’t work properly, this process is known as insulin resistance, which means that our cells either do not respond to insulin or responds to it sluggishly. A body with insulin resistance will need to produce more insulin to keep BG in a normal range. Over time, this “increased demand” on the pancreas—the organ that produces insulin in our body—may make it impossible for it to meet this need, and, as a result, the insulin it produces may decrease. This decrease in insulin production leads to increased BG levels that are higher than the normal range. Initially, this rise in BG is borderline, and may only occur after meals, when the insulin needed by the body to turn food into energy is high. This state of temporary increases in BG that result from decreases in insulin production is called prediabetes.
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Every year, 5-10% of people with prediabetes develop type 2 diabetes mellitus (DM), and 5-10% of these people may revert to normal. Individuals who have prediabetes tend to be inactive or sedentary, have high blood pressure and abnormal blood fat levels. Their risk of developing heart disease, stroke and circulation problems is increased.
Most people with prediabetes and early type 2 DM do not have symptoms and can remain unaware and undiagnosed for a long time, even several years. Sometimes complications of diabetes occur before these people have any symptoms of diabetes. This situation can only be prevented if people who are at high-risk for developing diabetes (see below) undergo regular checkups with their doctor and get appropriate blood tests. These tests may include measuring their blood glucose (BG) level, or the A1c test, which measures their average BG over the last three months, or the oral glucose tolerance test (see our video: Diabetes-the numbers).
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The cut off BG levels of prediabetes and type 2 diabetes are as follows:
| Cut off values | Fasting BG mg/dL | BG on OGTT* mg/dL | A1c* |
Diabetes Mellitus | ≥ 126 | ≥ 200 | ≤ 5.6 |
| Prediabetes | 100-125 | ≥ 140 & ≤ 200 | 5.6 to 6.4 |
| Normal | ≤ 99 | ≤ 140 | ≥ 6.5 |
Your risk of having prediabetes and eventually developing type 2 diabetes is higher if you are:
- overweight (as indicated specifically by carrying excess fat in the central part of the abdomen/belly area, which means a waist circumference greater than 40 inches in men and greater than 35 inches in women)
- older (usually aged greater than 45 years), or a member of a family whose older relatives have had or currently have type 2 diabetes
- someone who has high blood pressure
- someone who has a high level of fat in their blood (i.e., high blood triglyceride levels)
- someone who has polycystic ovarian syndrome (PCOS)
- someone who belongs to certain ethnic groups, such as African Americans, Latino Americans, South Asian Americans, Native Americans, etc.
- Someone who has had gestational diabetes.
Managing Prediabetes:
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Prediabetes usually occurs in patients who have a condition known as metabolic syndrome. Metabolic syndrome is a group of five conditions that often occur together, and that promote hardening of the arteries (atherosclerosis), which may lead to heart disease, diabetes, stroke, and other vascular complications.*
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If you have three out of the following five conditions, you have the metabolic syndrome:
- you are overweight (particularly in the central part of the abdomen/belly area), with an increased waist circumference (greater than 40 inches in men and greater than 35 inches in women)
- you have high blood pressure
- you have a high level of fat in your blood (high blood triglyceride levels)
- you have low blood levels of HDL (so-called “good cholesterol”)
- you have high BG (prediabetes or diabetes)
Luckily, daily lifestyle changes can help improve all of these conditions. These lifestyle changes include eating well-balanced meals, becoming more active, reducing stress and getting adequate sleep every day. . Some people who have been diagnosed as being prediabetic may need to be more aggressive and may need medications to prevent diabetes and cardiovascular disease. These medications may include:
- Metformin
- GLP-1 analogs ((such as Ozempic, Wegovy, Mounjaro, Saxenda, etc.).
Please see our articles: Prediabetes—the Good and the Bad, and Prediabetes— Why You Should Take It Seriously.
*A vascular complication refers to any type of condition that can interfere with the flow of blood to or from the body’s organs. This interference can be direct, and can take the form of a blood clot that blocks the flow of blood in a blood vessel, or indirect, such as what occurs when enough plaque builds up inside someone’s arteries to impede how blood flows through them.
