Do I have Pre-Diabetes and How Can I Prevent Diabetes?
What is Pre-Diabetes?
Pre-Diabetes, also known as “impaired glucose regulation,” is a condition whereby blood sugar levels are higher than normal, but not high enough to meet the threshold to diagnose Diabetes. Patients often have no symptoms.
This elevated blood sugar level can raise your risk of progression to Diabetes, but this is not absolute. Approximately 5-10% of patients with Pre-Diabetes continue to develop Type 2 Diabetes annually.
Research evidence suggests that Pre-Diabetes can be reversible if patients address lifestyle risk factors, such physical inactivity and being overweight. Engagement with the National Diabetes Prevention Programme (NDPP), a lifestyle intervention programme, has also been shown to reduce risk of progression to Diabetes.
Am I at risk?
Important risk factors to be considered are:
- AGE – The older you get, the greater your risk of developing Diabetes, particularly if you are Caucasian and over 40 years old, or African-Caribbean, Black African, or South Asian and over 25 years of age.
- FAMILY HISTORY – if a parent, sibling or child has Diabetes, the chance of having it is increased between 2 and 6 fold.
- ETHNICITY – South Asian, African-Caribbean of Black African ethnicities have a 2 to 4 times greater risk.
- MEDICAL HISTORY – The following factors also increase risk; having high blood pressure, being overweight, smoking, excess alcohol intake (more than 14 units/week), having a sedentary lifestyle, history of gestational Diabetes (in pregnancy), having polycystic ovarian syndrome and disturbed sleep patterns are also factors which can increase your risk.
- MEDICATION – some mental health medication can contribute to enhanced Diabetes risk.
- SOCIAL FACTORS – smoking, drinking excess alcohol, having an inactive lifestyle and experiencing disturbed sleep can also contribute to risk of Diabetes.
What is my risk?
In collaboration with the University of Leicester, Diabetes UK published a simple risk assessment tool to help determine the likelihood of someone developing Diabetes. Their quick and easy assessment tool is available at https://riskscore.Diabetes.org.uk/start
The tool will provide you with a risk score (low-risk is between 0-6, increased-risk is between 7-15, moderate-risk is 16 to 24 and high-risk is between 25-47).
What does the risk score mean?
The greater the risk, the higher the chance of someone developing Type 2 Diabetes over the next 10 years.
If your score identifies you in the high-risk category, you have a 1 in 4 (25%) chance of progressing to Diabetes in the next 10 years. This risk is further increased depending on your ethnicity. Diabetes can be prevented or delayed in 3 out of 5 people with this level of risk. You should see your GP to discuss this further and obtain a blood test to confirm or exclude the presence of the condition.
If your score identifies you in the moderate-risk category, you have a 1 in 10 (10%) chance of progressing to Diabetes in the next 10 years. You should see your GP to discuss this further and obtain a blood test.
If your score identifies you in the increased risk category, you have a 1 in 35 (~3%) chance of progressing to Diabetes in the next 10 years. Losing weight, becoming more activity and eating a healthy well-balanced diet can improve this risk.
If your score identified you in the low-risk category, you have a 1 in 100 (1%) chance of progressing to Diabetes in the next 10 years.
Is there any test for a Pre-Diabetes diagnosis?
A blood test named, HbA1c reflects the average amount of sugar in your blood over the preceding 3 months. The range for Pre-Diabetes is 6%-6.4% or 42-47mmol/mol.
Diabetes, however, is diagnosed as one reading equal to or above 6.5% (48mmol/mol) if you have symptoms and 2 readings a few weeks apart, above 6.5% if you do not have symptoms.
What treatments are available?
There are various treatment options available and aim to target your modifiable risk factors specifically; increasing physical activity, reducing weight, smoking cessation and eating a healthy, well-balanced, diet to name a few.
However, evidence has suggested that intensive lifestyle modification, in the form of structured education can really improve outcomes.
See this link for the National Diabetes Prevention Programme to find local support courses https://preventing-Diabetes.co.uk.
The American Diabetes Association suggest initiating treatment with Metformin – an insulin sensitising drug – to help prevent the progression of Diabetes. Here in the UK, this practice has not routinely been followed, but may be offered for some patients.
If you are found to have Pre-Diabetes, you must have a blood test every year for monitoring. If blood sugar levels do normalise, it remains good practice to still undertake annual screening.
What can I do myself?
Diabetes UK have produced information prescriptions with a wealth of advice of what can be done to take control.
- Reducing your risk of Type 2 Diabetes
- Be active to reduce your risk of Type 2 Diabetes
You can easily book an appointment with a GP in our team, or your NHS GP, to discuss your risk factors, arrange a blood test and agree an action plan focusing on your personal goals.
Tuso P. Prediabetes and lifestyle modification: time to prevent a preventable disease. The Permanente Journal. 2014;18(3):88.
About the Author
This article is by Dr. Vidya Kanthi, one of our expert GP’s at London City Healthcare. In her NHS practice she is a GP Appraiser and a Clinical Diabetes Lead in her Clinical Commissioning Group (CCG).