Pre-Diabetes

They are not classed diabetic but still have high glucose blood levels.

There are two main forms of pre-diabetes:

Impaired fasting glucose

• A person with impaired fasting glucose and impaired glucose tolerance indicates that they may be on the ‘borderline’ to develop diabetes, the development to diabetes occurs between 3-10 years.
• Impaired fasting glucose is normally is connected liver insulin resistance and near normal muscle insulin sensitivity.
• It also has a higher risk of heart conditions and metabolic syndrome than impaired glucose tolerance.

Impaired glucose tolerance

• Impaired glucose tolerance is connected with muscle insulin resistance and malfunction of insulin being released and is also more connected with obesity and age.

Diagnosis Tests

Testing should be considered in overweight or obese adults who have one or more of the following risk factors:

• First-degree relative with diabetes
• High-risk race/ethnicity (i.e. Black, Latinx, Native American, Asian American, Pacific Islander)
• History of cardiovascular disease
• Hypertension (high blood pressure) (≥ 140/90 mm Hg or on therapy for hypertension)
• High-density lipoprotein cholesterol level < 35 mg/dL (0.90 mmol/L) and/or a triglyceride level > 250 mg/dL (2.82 mmol/L)
• Polycystic ovary syndrome
• Physical inactivity
• Other clinical conditions associated with insulin resistance (i.e. severe obesity, acanthosis nigricans)
• Testing should begin at age 45 years.
• Testing for prediabetes and/or diabetes type 2 in asymptomatic patients should be considered in adults of any age who are overweight or obese and who have one or more additional risk factors for diabetes.
• Among Asian, a BMI ≥ 23 kg/m² is the threshold for  all other persons, a BMI ≥ 25, kg/m² is the threshold.

American Diabetes Association (ADA)

• Good sugar control in pregnancy

Diagnosis of Pre-diabetes

• Prediabetes diagnosis in nonpregnant adults with fasting plasma glucose level of 100-125 mg/dL (after ≥ 8 hours without caloric intake) or A1c of 5.7%-6.4%.
• Less frequently, a 2-hour oral glucose tolerance test result of 140-199 mg/dL confirms prediabetes.
• This condition can increase the chance of type 2 diabetes and other conditions i.e.
  • Atherosclerotic cardiovascular disease
  • Heart failure
  • Long term kidney disease
  • Pancreatic cancer

ADA Standards of Care in Diabetes

Diagnosis of diabetes includes any of the following:

• A fasting plasma glucose level ≥ 126 mg/dL (7 mmol/L); fasting is defined as no caloric intake for at least 8 hours
• A 2-hour plasma glucose level ≥ 200 mg/dL (11.1 mmol/L) or during a 75-g oral glucose tolerance test
• An A1c level ≥ 6.5% (≥ 48 mmol/mol)
• A random plasma glucose level ≥ 200 mg/dL (11.1 mmol/L) in a patient with classic symptoms of hyperglycemia (i.e. polyuria, polydipsia, polyphagia, weight loss) or hyperglycemic crisis
• Measuring concentrations of insulin or C-peptide (a fragment of proinsulin that serves as a marker for insulin secretion) is rarely necessary to diagnose diabetes type 2 or differentiate diabetes 2 from Diabetes type 1. Insulin levels generally are high early in the course of diabetes type 2 and gradually wane over time. A fasting C-peptide level > 1 ng/dL in a patient who has had diabetes for more than 1-2 years is suggestive of diabetes type 2  (i.e. residual beta-cell function).

American Diabetes Association (ADA)