Pre-diabetes is a condition where blood sugar (glucose) levels are higher than normal but not high enough to be classified as type 2 diabetes. It serves as a warning sign that you are at an increased risk of developing type 2 diabetes, heart disease, and stroke.

In the UK, pre-diabetes is identified using blood glucose tests:
Fasting plasma glucose (FPG): A test done after fasting (not eating) for at least 8 hours. In pre-diabetes:
Normal: Less than 5.5 mmol/L
Pre-diabetes: 5.5 – 6.9 mmol/L
Diabetes: 7.0 mmol/L or higher
HbA1c (glycated haemoglobin): This measures your average blood glucose level over the past 2–3 months.
Normal: Less than 42 mmol/mol
Pre-diabetes: 42 – 47 mmol/mol
Diabetes: 48 mmol/mol or higher

Implications of Pre-diabetes

Pre-diabetes doesn’t mean you will definitely develop type 2 diabetes, but it does indicate that you are at higher risk. If left untreated, about 1 in 3 people with pre-diabetes will develop type 2 diabetes within 5 years.

Pre-diabetes can also increase the risk of:

Cardiovascular Disease: High blood glucose levels damage blood vessels over time, raising the risk of heart attacks and strokes.
Nerve Damage: Even in pre-diabetes, elevated glucose can start to damage nerves, leading to numbness or tingling in extremities.
Kidney Disease: Higher glucose levels can strain the kidneys, increasing the risk of kidney damage.

Management of Pre-diabetes

Managing pre-diabetes effectively can delay or prevent the onset of type 2 diabetes and reduce the risk of cardiovascular disease. Key management strategies include:

1. Healthy Eating

Balanced Diet: A diet rich in fruits, vegetables, whole grains, and lean proteins can help control blood sugar levels. Limiting processed foods, sugary snacks, and refined carbohydrates is important.
Portion Control: Managing portion sizes can help prevent overeating and control weight.
Low Glycaemic Index (GI) Foods: Choosing foods that release glucose slowly (like whole grains, legumes, and non-starchy vegetables) can help keep blood sugar levels stable.
Learn more about healthy eating here: NHS - Healthy Eating and Diabetes Prevention

2. Regular Physical Activity

Exercise helps the body use insulin more effectively, lowering blood sugar levels. Aim for at least 150 minutes of moderate-intensity exercise per week, such as brisk walking, cycling, or swimming.
Strength training (like weight lifting) and aerobic exercises (like running) can both help improve insulin sensitivity and reduce the risk of developing diabetes.
Read more about physical activity guidelines here: NHS - Exercise and Diabetes Prevention

3. Weight Management
Maintaining a healthy weight is one of the most effective ways to manage pre-diabetes. Losing 5-10% of your body weight can significantly reduce the risk of developing type 2 diabetes.

4. Stop Smoking

Smoking increases insulin resistance and contributes to inflammation, which can accelerate the progression to type 2 diabetes.
More about quitting smoking: NHS - Stop Smoking

5. Monitor Blood Glucose Levels

For some people with pre-diabetes, regular monitoring of blood sugar levels can help track progress and guide lifestyle changes. Your healthcare provider can advise on whether you should monitor your glucose levels regularly.

6. Medications (If Necessary)

In some cases, medications such as metformin may be prescribed to lower blood glucose levels, especially for those at high risk of progressing to diabetes. However, lifestyle changes remain the most effective strategy for managing pre-diabetes.
Conclusion

Pre-diabetes is a serious condition, but it can often be reversed with lifestyle changes. Adopting a healthy diet, engaging in regular physical activity, losing excess weight, and quitting smoking are key strategies to prevent the progression to type 2 diabetes.
Reliable References for Further Reading:
NHS: NHS - Pre-diabetes and Diabetes Prevention
Diabetes UK: Diabetes UK - What is Pre-diabetes?
World Health Organization (WHO): WHO - Diabetes Prevention

Dr Geranmayeh