people develop type 2 diabetes, they almost always have
"pre-diabetes" -- blood glucose levels that are
higher than normal but not yet high enough to be diagnosed as
diabetes. At least 16 million people in the
the population), ages 40 to 74, have
pre-diabetes. Recent research has shown that some
long-term damage to the body, especially the heart and
circulatory system, may already be occurring during
research has also shown that if you take action to control
your blood glucose when you have pre-diabetes, you can delay
or prevent type 2 diabetes from ever
developing. The American Diabetes Association has
just published a Position Statement on "The Prevention or
Delay of Type 2 Diabetes" to help guide health care
professionals in treating their patients with pre-diabetes.
is a lot you can do yourself to know your risks for
pre-diabetes and to take action to prevent diabetes if you
have, or are at risk for, pre-diabetes. The American
Diabetes Association has a wealth of resources for people with
diabetes. People with pre-diabetes can expect to benefit
from much of the same advice for good nutrition and physical
activity. The links on this page are cornerstones of
successful management of pre-diabetes.
scientific and medical basis for identifying pre-diabetes as a
serious health threat is laid out in a new Position Statement
Prevention or Delay of Type 2 Diabetes". The
statement has been issued jointly by the American Diabetes
Association and the National Institute of Diabetes and
Digestive and Kidney Diseases.
DO YOU TELL IF YOU HAVE PRE-DIABETES?
are two different tests your doctor can use to determine
whether you have pre-diabetes: the fasting plasma glucose test
(FPG) or the oral glucose tolerance test (OGTT). The
blood glucose levels measured after these tests determine
whether you have a normal metabolism, or whether you have
pre-diabetes or diabetes. If your blood glucose level is
abnormal following the FPG, you have impaired fasting glucose
(IFG); if your blood glucose level is abnormal following the
OGTT, you have impaired glucose tolerance (IGT).
American Diabetes Association Risk
Test for Diabetes can help you determine if you are at
increased risk for diabetes or pre-diabetes. A high
score may indicate that you have pre-diabetes or at risk for
the test and find out for sure.
YOU CAN DO
is a serious medical condition that can be treated. The
good news is that the recently completed Diabetes Prevention
Program study conclusively showed that people with
pre-diabetes can prevent the development of type 2 diabetes by
making changes in their diet and increasing their level of
physical activity. They may even be able to return their
blood glucose levels to the normal range.
the DPP also showed that some medications may delay the
development of diabetes, diet and exercise worked better.
Just 30 minutes a day of moderate physical activity,
coupled with a 5-10% reduction in body weight, produced a 58%
reduction in diabetes.
American Diabetes Association is developing materials that
will help people understand their risks for pre-diabetes and
what they can do to halt the progression to diabetes and even
to, "turn back the clock." In the meantime,
has a wealth
of resources for people with diabetes or at risk for diabetes
that can be of use to people interested in pre-diabetes.
guide to the basics of eating healthy
statement for health care professionals on nutrition
American Diabetes Association bookstore has award-winning
books on nutrition, recipes, weight loss, meal planning
on how to include a healthy amount of physical activity into
your daily routine:
Asked Questions: Exercise and Diabetes
statement for health care professionals on exercise
can get fit, reduce your risk for type 2 diabetes, and support
the American Diabetes Association by participating in America's
Walk for Diabetes.
What is pre-diabetes and how is it different from diabetes?
Pre-diabetes is the state that occurs when a person's blood
glucose levels are higher than normal but not high enough for
a diagnosis of diabetes. About 11 percent of people
with pre-diabetes in the Diabetes Prevention Program standard
or control group developed type 2 diabetes each year during
the average 3 years of follow-up. Other studies show that most
people with pre-diabetes develop type 2 diabetes in 10 years.
Is pre-diabetes the same as Impaired Glucose Tolerance or
Impaired Fasting Glucose?
Yes. Doctors sometimes refer to this state of elevated blood
glucose levels as Impaired Glucose Tolerance or Impaired
Fasting Glucose (IGT/IFG), depending on which test was used to
Why do we need to give it a new name? Has the condition
The condition has not changed, but what we know about it has.
We are giving IGT/IFG a new name for several reasons.
Pre-diabetes is a clearer way of explaining what it means to
have higher than normal blood glucose levels. It means you are
likely to develop diabetes and may already be experiencing the
adverse health effects of this serious condition. People with
pre-diabetes are at higher risk of cardiovascular disease.
People with pre-diabetes have a 1.5-fold risk of
cardiovascular disease compared to people with normal blood
glucose. People with diabetes have a 2- to 4-fold increased
risk of cardiovascular disease. We now know that people with
pre-diabetes can delay or prevent the onset of type 2 diabetes
through lifestyle changes.
How do I know if I have pre-diabetes?
Doctors can use either the fasting plasma glucose test (FPG)
or the oral glucose tolerance test (OGTT) to detect
pre-diabetes. Both require a person to fast overnight. In the
FPG test, a person's blood glucose is measured first thing in
the morning before eating. In the OGTT, a person's blood
glucose is tested after fasting and again 2 hours after
drinking a glucose-rich drink.
How does the FPG test define diabetes and pre-diabetes?
blood glucose is below 110 mg/dl. A person with pre-diabetes
has a fasting blood glucose level between 110 and 125 mg/dl.
If the blood glucose level rises to 126 mg/dl or above, a
person has diabetes.
How does the OGTT define diabetes and pre-diabetes?
In the OGTT, a person's blood glucose is measured after a fast
and 2 hours after drinking a glucose-rich beverage.
blood glucose is below 140 mg/dl 2 hours after the drink.
pre-diabetes, the 2-hour blood glucose is 140 to 199 mg/dl.
the 2-hour blood glucose rises to 200 mg/dl or above, a person
Which test is better?
According to the expert panel, either test is appropriate to
Why do I need to know if I have pre-diabetes?
If you have pre-diabetes, you can and should do something
about it. Studies have shown that people with pre-diabetes can
prevent or delay the development of type 2 diabetes by up to
58 percent through changes to their lifestyle that include
modest weight loss and regular exercise. The expert panel
recommends that people with pre-diabetes reduce their weight
by 5-10 percent and participate in some type of modest
physical activity for 30 minutes daily. For some people with
pre-diabetes, intervening early can actually turn back the
clock and return elevated blood glucose levels to the
Will my insurance cover testing and treatment?
Because all insurance plans are different, this is a difficult
question to answer. However, Medicare and most insurance plans
cover diabetes testing for people suspected of having
diabetes. People at risk for diabetes are also at risk for
pre-diabetes. Since the test is the same and the risk factors
are the same for both conditions, a pre-diabetes test may be
covered. It is best to consult your physician and health
insurance representative with specific coverage questions.
What is the treatment for pre-diabetes?
Treatment consists of losing a modest amount of weight (5-10
percent of total body weight) through diet and moderate
exercise, such as walking, 30 minutes a day, 5 days a week.
Don't worry if you can't get to your ideal body weight. A loss
of just 10 to 15 pounds can make a huge difference. If you
have pre-diabetes, you are at a 50 percent increased risk for
heart disease or stroke, so your doctor may wish to treat or
counsel you about cardiovascular risk factors, such as tobacco
use, high blood pressure, and high cholesterol.
Who should get tested for pre-diabetes?
If you are overweight and age 45 or older, you should be
tested for pre-diabetes during your next routine medical
office visit. If your weight is normal and you're over age 45,
you should ask your doctor during a routine office visit if
testing is appropriate. For adults younger than 45 and
overweight, your doctor may recommend testing if you have any
other risk factors for diabetes or pre-diabetes. These include
high blood pressure, low HDL cholesterol and high triglycerides,
a family history of diabetes, a history of gestational
diabetes or giving birth to a baby weighing more than 9
pounds, or belonging to an ethnic or minority group at high
risk for diabetes.
How often should I be tested?
If your blood glucose levels are in the normal range, it is
reasonable to be retested every 3 years. If you have
pre-diabetes, you should be tested for type 2
diabetes every 1-2 years after your diagnosis.
Could I have pre-diabetes and not know it?
Absolutely. People with pre-diabetes don't often have
symptoms. In fact, millions of people have diabetes and don't
know it because symptoms develop so gradually, people often
don't recognize them. Some people have no symptoms at all.
Symptoms of diabetes include unusual thirst, a frequent desire
to urinate, blurred vision, or a feeling of being tired most
of the time for no apparent reason.
Should children be screened for pre-diabetes?
We are not recommending screening children for pre-diabetes
because we don't have enough evidence that type 2 diabetes can
be prevented or delayed in children at high risk for the
disease. However, a study published in the
, issue of
the New England Journal of Medicine found 25 percent of
very obese children and 21 percent of very obese adolescents
had pre-diabetes. If future studies show that early
intervention also works for children, a recommendation could