The term “diabetes” is used to describe a group of conditions that are characterized by hyperglycemia, or high blood glucose. Depending on the cause of your diabetes, you either do not make enough insulin to control your blood glucose, or your body does not respond efficiently to the insulin you produce. People who do not respond appropriately to insulin are said to be insulin resistant. Insulin resistance is the driving force behind type 2 diabetes, and it is the hallmark of prediabetes, which doctors used to call “borderline diabetes.”
Glucose, the primary source of energy for cellular metabolism, is obtained from carbohydrates in your diet. While glucose is necessary for life, having too much glucose in your bloodstream can lead to health problems. Before your cells can absorb glucose from your bloodstream, they must be stimulated by insulin, which is produced by your pancreas. Thus, insulin is a dual-purpose hormone that makes metabolic fuel available to your cells while helping to maintain your blood glucose at a safe level. In people with prediabetes, the cellular response to insulin is impaired. Their blood glucose levels are higher than normal but not high enough to be diagnosed as diabetes.
In 2010, as part of an effort to detect diabetes in more people at an earlier stage, when treatment could prevent long-term complications, the American Diabetes Association updated its diagnostic criteria. If your blood glucose lies between 100 and 125 mg/dL after an 8-hour fast, you have prediabetes. Similarly, if your blood glucose is between 140 and 199 mg/dL following a 2-hour oral glucose tolerance test or your hemoglobin A1C is between 5.7 and 6.4 percent, you have prediabetes. All of these tests can be performed at your doctor’s office.
Increased Diabetes Risk
People with prediabetes are at increased risk for type 2 diabetes, which itself is a risk factor for heart disease, stroke, kidney failure, vision loss and premature death. However, if you have prediabetes, you are not necessarily destined to develop type 2 diabetes. Research shows that people with prediabetes can prevent or delay progression to type 2 diabetes by losing 5 to 7 percent of their body weight, if they are overweight, and by getting at least 150 minutes of moderate exercise each week. A study published in the February 2002 issue of “The New England Journal of Medicine” demonstrated that metformin, a drug that improves insulin sensitivity, may also be of benefit for people with prediabetes.
People with prediabetes -- what was formerly called “borderline diabetes” -- may be able to prevent or delay progression to full-blown diabetes with lifestyle changes, medications or a combination of the two. However, to know if such interventions are necessary, you must first see your physician to get screened for diabetes. According to the Centers for Disease Control and Prevention, one-third of American adults have prediabetes, but less than 10 percent of these individuals have been informed they have the condition. Ask your doctor if you should be screened for diabetes.
- Centers for Disease Control and Prevention: Diabetes Report Card, 2012
- Diabetes Care: Standards of Medical Care in Diabetes -- 2010
- American Family Physician: Diabetes Mellitus -- Diagnosis and Screening
- The New England Journal of Medicine: Reduction in the Incidence of Type 2 Diabetes With Lifestyle Intervention or Metformin
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