What it means to have prediabetes and the three most important changes that can stop it from setting in

More than 634 million adults worldwide live with impaired glucose tolerance, a form of prediabetes, according to the latest edition of IDF Diabetes Atlaspublished by the International Diabetes Federation. Estimates show that by 2050, the number could rise to around 846 million. In Romania, dATES The IDF for 2024 indicates approximately 1.32 million adults with diabetes and an additional 568,500 with impaired glucose tolerance, a stage that, without intervention, frequently leads to type 2 diabetes.

The good news is that prediabetes can be reversed. If detected in time, blood sugar can return to normal values ​​through lifestyle changes, without the need for long-term drug treatment. Research shows that weight loss, regular physical activity and quitting smoking can reduce the risk of developing type 2 diabetes by up to 58%.

What is prediabetes and why it often goes undiagnosed

Prediabetes is an intermediate stage in which blood sugar levels are higher than normal, but not high enough to warrant a diagnosis of type 2 diabetes. Specifically, a healthy blood sugar is between 70 and 99 mg/dL. When the values ​​oscillate between 100 and 125 mg/dL, we talk about prediabetes. Above 126 mg/dL, the diagnosis becomes diabetes.

According to the Cleveland Clinic, for a 45-year-old diagnosed with prediabetes, the risk of developing type 2 diabetes in the next decade is estimated to be between 9% and 14%. However, the percentage increases with age and with the accumulation of other risk factors.

Detection is difficult precisely because, most of the time, prediabetes does not cause symptoms. Many people do not feel anything unusual and only end up investigating by chance. For this reason, the surest method of finding out if there is prediabetes remains periodic blood tests.

In rare cases, there may be signs such as dark spots on the neck or armpits (acanthosis nigricans), skin papillomas or eye changes that may evolve into diabetic retinopathy.

Insulin resistance, the underlying cause

At the base of prediabetes is the same mechanism that causes type 2 diabetes: insulin resistance. In other words, cells in the muscles, fat tissue and liver no longer respond well enough to insulin, the hormone produced by the pancreas that helps the body use blood sugar.

When the body doesn't use insulin effectively, glucose stays in the blood instead of being taken up by cells to produce energy. Thus, high blood sugar levels appear, and over time, excess sugar can damage blood vessels and nerves.

There are several factors that contribute to insulin resistance, including:

• genetic predisposition,
• excess abdominal fat (especially visceral fat, which surrounds the internal organs),
• sedentarism,
• frequent consumption of ultra-processed foods, rich in carbohydrates and saturated fats.

Added to this list are the long-term use of drugs such as corticosteroids, hormonal disorders such as hypothyroidism or Cushing's syndrome, chronic stress and poor quality sleep.

Who is at risk?

The risk factors for prediabetes are multiple and, unfortunately, not all of them can be controlled. Those that do not depend on willpower include age (people over 45 are more vulnerable), family history (if a parent or sibling has type 2 diabetes), and belonging to certain ethnic groups.

Instead, other factors can be changed:

• overweight (body mass index over 25),
• lack of regular physical activity (less than three workouts per week),
• smoking,
• obstructive sleep apnea,
• polycystic ovary syndrome,
• history of gestational diabetes.

The more risk factors you accumulate, the more likely you are to already have prediabetes or develop it soon. Therefore, the discussion with the family doctor about screening for prediabetes should not be delayed.

Possible complications

The main risk of prediabetes is progression to type 2 diabetes. And undiagnosed or poorly controlled diabetes increases the likelihood of serious complications, from heart attack and stroke to kidney (diabetic nephropathy), nerve (diabetic neuropathy) and eye damage, sometimes with vision loss.

Prediabetes can, in many cases, be brought back to better values ​​by changes made in time. If the disease progresses and complications arise, it becomes more difficult to correct, and some lesions may remain permanent.

How is the diagnosis made?

Prediabetes is diagnosed based on blood tests. The two commonly used tests are the fasting blood glucose test (which measures blood sugar after at least eight hours without eating) and the glycosylated hemoglobin (HbA1c) test, which gives an average of the blood sugar over the past two to three months.

If fasting blood glucose is between 100 and 125 mg/dL or HbA1c is between 5.7% and 6.4%, the diagnosis is prediabetes. Values ​​below 100 mg/dL, or below 5.7%, are considered normal, while above 126 mg/dL or 6.5% HbA1c means diabetes.

Three changes that can stop prediabetes

In the case of prediabetes, lifestyle changes may be even more effective than medication. Below are the three most important interventions.

1. Weight loss, even a few pounds

If there are extra pounds, losing weight is one of the fastest ways to improve blood sugar. Often there is no need for spectacular changes. A 5-10% drop in body weight can be enough to bring blood sugar back into better range.

A study cited by the Cleveland Clinic demonstrated that a 7% weight loss can reduce the risk of type 2 diabetes by 58%. For a 90-pound person, that's about 6-6.5 pounds, a realistic and achievable target.

To achieve this goal, experts recommend reducing portions, limiting foods high in fat (especially saturated), sugar, and simple carbohydrates, while increasing consumption of fruits, vegetables, lean proteins, and whole grains. The Mediterranean diet is frequently cited as a suitable dietary pattern for people with prediabetes.

2. Regular movement

Physical activity is just as important as diet. The standard recommendation is 30 minutes of moderate-intensity aerobic exercise (brisk walking, cycling, swimming) five days a week. In addition to these, strength training, with weights or elastic bands, at least twice a week is also recommended.

Strength training builds muscle mass, which helps lower blood sugar, improve the body's response to insulin, and burn calories even at rest.

According to the Cleveland Clinic, a single session of moderate intensity exercise can increase the amount of glucose used by the muscles by at least 40%, thus helping to lower blood sugar. The effect is immediate and measurable.

3. Quitting smoking

Smoking is associated with a higher risk of type 2 diabetes. In some analyses, smokers had a 30–40% higher risk than nonsmokers of developing the disease. And for people who already have diabetes, cigarettes mean a greater risk of complications, especially cardiovascular, but also ocular, up to vision impairment. The earlier quitting happens, the lower the long-term risks.

Other measures that help

In addition to the three main interventions, there are other useful strategies. Stress management, treatment of sleep disorders (including sleep apnea), cholesterol and blood pressure control, are mentioned by the Cleveland Clinic as complementary measures that support the return of blood sugar to normal values.

When medication is needed

Lifestyle changes may be enough for many people with prediabetes, but not for all. In certain situations, the doctor may also recommend drug treatment, most commonly metformin, especially when there are additional risk factors, such as low HDL cholesterol (“good cholesterol”), elevated triglycerides, obesity, or a family history of diabetes.

However, pharmacological treatment does not replace a healthy lifestyle, but complements it. Patients taking metformin should continue to eat a balanced diet, exercise, and see their doctor regularly for follow-up.

What follows after the diagnosis

For many people, the diagnosis of prediabetes comes with anxiety and the feeling that everything has to change all at once. In practice, sustainable interventions are those that are built gradually and consistently tracked. Small goals are more likely to turn into a routine than a radical plan that is difficult to maintain.

If, despite all efforts, prediabetes progresses to type 2 diabetes, it is not a lack of discipline. Type 2 diabetes involves complex biological mechanisms, and the course differs from person to person.

Another helpful thing is social support. When those close to you understand what prediabetes entails and what changes are needed, it becomes easier to adhere to them in the long term.

What is worth watching in the long run

Even when blood sugar returns to better values, periodic checks are still useful. The body changes over time, and some measures that work for a while may need adjustments later. The family doctor or endocrinologist can set the pace of tests and consultations, depending on each person's profile.

Questions you can ask your doctor include:

• What can I do, concretely, to reduce the risk of type 2 diabetes;
• What is the ideal body weight for me;
• What type of physical activity suits me, depending on age and health;
• It makes sense to go to a nutritionist.