As our bodies age, the risk of developing type 2 diabetes steadily rises. Type 2 diabetes stands as the most prevalent form of diabetes, characterized by the improper utilization of insulin by the body. This condition necessitates long-term management. According to the Centers for Disease Control and Prevention, approximately 33 percent of individuals aged 65 or older are living with diabetes, and nearly half of older adults in the 65 and above age group have prediabetes.
It’s important to be educated on this chronic disease to manage a prediabetes diagnosis. We asked VIPcare’s Jacksonville primary care provider Dr. Silvia Abreu Read to share her knowledge on this most important topic. Board-certified in Internal Medicine, Dr. Read is a Fellow of the American College of Physicians (FACP) and a diabetologist specializing in the research and treatment of all types of diabetes.
What is prediabetes?
Prediabetes is a precursor to diabetes mellitus type 2, defined by higher-than-normal glucose levels but not as high as in diabetes. There are no clear symptoms of prediabetes, so you may have it and not know it. But before people develop type 2 diabetes, they almost always have prediabetes—where blood glucose levels are higher than normal but not yet high enough to be diagnosed as diabetes.
What are the risk factors for prediabetes?
- Family history of diabetes mellitus in a first-degree relative
- High-risk race/ethnicity (eg, African, Latino, Asian, or Native American descent)
- Sedentary lifestyle
- Hypertension
- Dyslipidemia
- History of cardiovascular disease
- Polycystic ovary syndrome (women)
How is prediabetes diagnosed?
- Impaired fasting glucose (IFG) – FPG between 100 and 125 mg/dL.
- Impaired glucose tolerance (IGT) – Two-hour plasma glucose value during a 75 g OGTT between 140 and 199 mg/dL.
- A1C – Persons with A1C 5.7 to <6.5 percent
| 1. Testing should be considered in overweight or obese (BMI ≥25 kg/m2 or ≥23 kg/m2 in Asian Americans) adults who have 1 or more of the following risk factors: ■ First-degree relative with diabetes
■ High-risk race/ethnicity (eg, African American, Latino, Native American, Asian American, Pacific Islander) ■ History of CVD ■ Hypertension (≥140/90 mmHg or on therapy for hypertension) ■ HDL cholesterol level <35 mg/dL (0.90 mmol/L) and/or a triglyceride level >250 mg/dL (2.82 mmol/L) ■ History of PCOS ■ Physical inactivity ■ Other clinical conditions associated with insulin resistance (eg, severe obesity, acanthosis nigricans) |
| 2. Patients with prediabetes (A1C ≥5.7% [39 mmol/mol], IGT, or IFG) should be tested yearly. |
| 3. Patients with a history of GDM should have lifelong testing at least every 3 years. 4. For all other patients, testing should begin at age 35 years. |
| 5. If results are normal, testing should be repeated at a minimum of 3-year intervals, with consideration of more frequent testing depending on initial results and risk status. |
| 6. Persons with HIV. |
What lifestyle changes can help prevent or manage prediabetes?
All patients should be counseled related to smoking cessation, diet, and exercise.
Exercise — Although there is no one exercise prescription for all individuals, adults at high risk for diabetes are encouraged to perform 30 to 60 minutes of moderate-intensity aerobic activity on most days of the week (at least 150 minutes of moderate-intensity aerobic exercise per week). The benefit of exercise in preventing diabetes has been demonstrated in several studies Additional benefits were seen with higher levels of activity (300 min/week, relative risk 0.64, 95% CI 0.56-0.73). Men who combined aerobic and weight training exercises had the greatest reduction in diabetes risk.
Diet — We suggest choosing a dietary pattern of healthful foods, such as the Dietary Approaches to Stop Hypertension (DASH) or Mediterranean-style diet, rather than focusing on a specific nutrient. This approach allows greater flexibility and personal preference in diet and may improve long-term adherence.
Smoking — Several large, prospective, observational studies have shown that cigarette smoking increases the risk of type 2 diabetes. Smoking cessation may reduce diabetes risk by reducing systemic inflammation. On the other hand, smoking cessation is often associated with weight gain, which will increase the risk of diabetes.
Drug therapy may be helpful in preventing type 2 diabetes in high-risk patients for whom lifestyle interventions fail or are not sustainable. Lifestyle changes, which are at least as effective and may be cheaper than most drugs used in prevention trials, are considered first-line preventive therapy.
Are there any dietary recommendations for someone trying to manage prediabetes?
We suggest choosing a dietary pattern of healthful foods, such as the Dietary Approaches to Stop Hypertension (DASH) or Mediterranean-style diet, rather than focusing on a specific nutrient.
There are three main types of carbohydrates in food—starches, sugar, and fiber. The goal is to choose carbs that are nutrient-dense, which means they are rich in fiber, vitamins and minerals, and low in added sugars, sodium, and unhealthy fats. When choosing carbohydrate foods:
- Eat the most of these: whole, unprocessed, non-starchy vegetables. Non-starchy vegetables like lettuce, cucumbers, broccoli, tomatoes, and green beans have a lot of fiber and very little carbohydrate, which results in a smaller impact on your blood glucose.
- Eat some of these: whole, minimally processed carbohydrate foods. These are starchy carbohydrates and include fruits like apples, blueberries, strawberries, and cantaloupe; whole intact grains like brown rice, whole wheat bread, whole grain pasta, and oatmeal; starchy vegetables like corn, green peas, sweet potatoes, pumpkin, and plantains; and beans and lentils like black beans, kidney beans, chickpeas, and green lentils.
- Try to eat less of these: refined, highly processed carbohydrate foods and those with added sugar. These include sugary drinks like soda, sweet tea, and juice, refined grains like white bread, white rice, and sugary cereal, and sweets and snack foods like cake, cookies, candy, and chips.
How often should patients have their blood sugar levels checked to manage prediabetes?
Patients with prediabetes don’t need to check their glucose levels.
What are the long-term implications of prediabetes, and how can patients lower their risk of developing full-blown diabetes?
You may develop diabetes mellitus type 2 and its complications. Refer to above lifestyle recommendations to lower risk of developing diabetes.
What support or guidance can patients expect from their healthcare provider in managing prediabetes?
Coaching about nutrition, exercise, and offering medications if indicated.
Silvia Abreu Read, M.D.
Board-certified in Internal Medicine, Dr. Silvia Read is a Fellow of the American College of Physicians (FACP) and a diabetologist specializing in the research and treatment of all types of diabetes.
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